Instrument, Installation & Maintenance Co.

Job Safety Observation Report No: IMCO_JSO_14

P. O. Box 22803, Doha, Qatar
Tel no. 0974-466-79-10/23/24 REPORT Project Title: EPIC FOR POWER
SUPPLY TO DSSA & NWDH

Describe in detail the Job Safety Observation: (including scenarios and recommendations)
_________________________________________________________________________________________________
Date of Job Safety Observation: 28, August’ 07 Time of JSO: 10:00 am
Person Involved: Management Company Name: Qatar Al Atiyah
Nationality: Indian, Nepali & Bangladesh Badge Number: Sub Contractor
Location of Incident: 33kV sub station Urinal IMCO Worksite Supervisor: Mhd. Abdul Rahman

Brief Description of incident:

At around 10:00 am a portable septic tank was already full and causing of sewage overflow, it will create a bad
smell in the surrounding and pollutant or contaminating the hazards.

Attach separate sheets if insufficient space; NOTE IMCO_FO_JSO_019a

Action Taken:
Immediately close and padlock the toilet room and inform to the site engineer the condition of the urinal of
their workers.

State actions taken to correct and prevent such occurrence: If closed what evidence have you to verify:
If still OPEN state measures for closure:

Recommendation;

1) Make the temporary urinal for the workers by using portalet.

2) QAIG management should aware to the health hazards of their employee.
3) Maintain the collection of waste in septic regularly.
4) Avoid overflowing the septic and causing harm to the workers.

Confirm if Job Safety Observation is Open or Closed

OPEN CLOSED

If closed sign: Safety Officer: I hereby confirm that the Job Safety Observation has been closed and corrective preventive
methods applied

Signature: Krishna Hari Date open: Date closed:

Reported By: Reviewed and Checked by HSE In-Charge ONLY:

Name: Krishna Hari Name: Francis E. Tan

Signature: Date: 28, Aug.’07 Signature: Date:

Designation: Safety Officer Confirm closure if applicable
Are their attachments
YES NO Closed: YES NO
Note: Form must be completed in all sections where possible; clear precise legible reporting must be made, ensure that any
attachments are correctly filled out and stabled or adequately clipped

Form Created: 16_January_07 IMCO_FO_JSO_019

Form revision # : 0