PROCUREMENT & CONTRACTOR MANAGEMENT

OHS-PR-02-22-F05 OHS NON-CONFORMANCE ISSUE FORM

OHS NON-CONFORMANCE & VIOLATION ISSUE / APPROVAL FORM No:

Name Company No. Name Company No.
From: Contract To: Contract
Holder Sponsor
Contract Title
Contract Contract No.
Sub - Contractor Vehicle No:
Authorization for a Non-Conformance/Violation from Agreed OHS Rule or Requirement(s)
Details of Non-Conformance: 1. Job Stoppage
(procedure, method, equipment, etc.) 2. □ Yes □ No

Previous: Non-Conformance □ Yes □ No

If Yes: Details
Reason(s) for Non-Conformance 1.
2.
Duration of Non-Conformance: Start Date: End Date:
Time: Time:
Details of Control Measures: Hazards Additional Controls
1. 1.
2. 2.
3. 3.

Action Recommended : □ Written Warning □ Penalty SAR ………………………………..

□ Suspension □ Dismissal
□ Other………………………………………………………………
Other Comments:
Issuer of Non-Conformance Name Designation Signature Date
/ Violation

Activities in the Contract covered by this OHS Non-Conformance/ Violation application will not be allow to
proceed until a plan of action is implemented to execute the Job/Task/Process in a safe, healthy and
environmentally responsible manner.

Contracts / Projects
Name Signature Date
Representatives
Contractors Manager
Project Manager
SEC OHS Representative
□ I hereby approve the Non –Conformance (Violation) be allowed for this Project.
□ I hereby allow work to proceed, subject to full implementation of the OHS risk management controls and
agreed action plan.
Name Signature Date
SEC Contract /Project
Owner

Page 1 of 1 Rev 0 [May-2020] OHSMS Approved Document