Name: Designation Signature

1. Mr. K. V. Rao Project Manager ( Zeeco)

2. Mr. Jayaraj Natarajan RCM ( Zeeco)

3. Mr. Michael Agnael Planning Manager (Zeeco)

4. Mr. Dashrath Singh HSE (Zeeco)

5. Mr. Shanmugham .A RCM (TKIS)

6. Mr. Abdul Allam HSE (TKIS)

PART-B : Compliance Audit by JSA Team Members while the Job is being executed :

Recommended Actions /Procedures & Control Checked By Name of Officer with

Sl. No. Observations Compliance Status
Measures Sign. date & time