Non-Conformance Report Form

Identification
Contractor name MACHMT ALKHALEEJ CONT. CO. Date 18/10/2021
Location PREMIER PLASTIC COMPANY Time 8:45 A.M.

Non-Conformance classification
Health  Safety  Environment ☐ Quality ☐

Purpose of site visit

Audit ☐ Inspection  Investigation ☐

Actual or Potential Risk Rating

High  Medium ☐ Low ☐

Non-Conformance Description
Details on what happened during site visit

1) WORKERS WERE FOUND AT SITE WORKING WITHOUT ANY SAFETY SHOES.

2) WORKERS WERE IN APPROPRIATE UNIFORM.
3) WORKING AT HEIGHT WITHOUT AND SAFETY HAT OR EDGE PROTECTION GUARD.
4) CIVIL WORKS BEING CARRIED OUT WITH ANY HANDGLOVES AND MASK TO PROTECT FROM CEMENT DUST.
5) CARRYING TOBACCO INSIDE PLANT PREMISES, EVEN THOUGH THE “NO SUBSTANCE MISUSE POLICY” HAS BEEN CLEARLY COMMUNICATED.

Immediate Action/Instructions

1) USING ALL PPE AS PER JOB i.e. PROPER COVER ALL, HAND GLOVES, SAFETY HELMET, FACE SHEILD, EAR PLUGS, SAFETY BELT.
2) USING ALL EQUIPMENTS NECESSARY FOR WORK AT HEIGHT.
3) NO SUBSTANCE MISUSE OR CARRING ANY KIND OF TOBACCO INSIDE PLANT PREMISES.

Visit Findings (attach photos to substantiate the findings) / Attach on next page

 PICTURES ATTACHED

Proposed Corrective and Preventive Action

1) FOLLOWING THE HSSE POLICY OF SITE.

2) USING ALL PPE AS PER JOB i.e. COVER ALL, HAND GLOVES, SAFETY HELMET, FACE SHEILD, EAR PLUGS, and SAFETY BELT.
3) USING ALL EQUIPMENTS NECESSARY FOR WORK AT HEIGHT

Follow up on action and result

Action Sufficient? THIS IS THE SECOND NC WITHIN 3 WEEKS AND THIS IS FINAL NC BEING GIVEN AFTER WHICH THE PEOPLE WOULD NOT
ALLOWED TO ENTER WORKPLACE PREMISES.

Close out ☐ Date _________________________ Re-issue  Date 28/9/2021

CONTRACTOR REPRESENTATIVE SIGN. ________________________

DATE: _________________________________
PPC/HSSE/F 048/Rev. 0 Dated 26/03/2021
PICTURES:

PPC/HSSE/F 048/Rev. 0 Dated 26/03/2021