Instrument, Installation & Maintenance Co.

Job Safety Observation Report No: IMCO_JSO_08

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: 24, August’ 07 Time of JSO: 08:00 am
Person Involved: All QAIG Workers Company Name: Qatar Al Atiyah
Nationality: Indian, Nepali & Bangladesh Badge Number: Sub Contractor
Location of Incident: 33kV sub station IMCO Worksite Supervisor: Mhd. Abdul Rahman

Brief Description of incident:

At the time when the QAIG sub contractor of IMCO making rebar for slab beam of 33kV sub station at the
height of 1 meter above the flooring they are using them as a bridge to transfer to another area of the
substation which is hazards for a possible trips and falls.

Attach separate sheets if insufficient space; NOTE IMCO_FO_JSO_019a

Action Taken:
Immediately instructed the workers for their unsafe acts and not to do so.

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 step ladder as their access.
2) Worksite supervisor should aware for the unsafe acts of his workers.
3) Identify those hazards that cause you in slip, trip and fall.
4) To avoid trips, keep the pathways and work areas clean.
5) Never, ever attempt to walk trough the beam slab that will cause you to accident.

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: Roger P. Drillon Date open: Date closed:

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

Name: Roger P. Drillon Name: Francis E. Tan

Signature: Date: 24, 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