HSE NON-CONFORMITY REPORT

Location: Date: 29/12/2022 Ref No:

Gas Collector TT 03 Time: 16.55 HEC-HSE-NCR-

Department/Subcontractor: Mechanical / JEL PTW No.:

Description of Work in Progress:

1. Details of Non-conformity
- Stacks of cable trays and scaffold pipes left unattended on top of transfer tower

2. Action to be taken
The following Safety Improvements shall be completed by Date: Time:
- Move cable trays and scaffold pipes to another secure place or keeping them into storage

Notice Issued By: Acknowledged By: Verified By:

(HEC Construction/HSE) (Subcontractor HSE Officer) (Subcontractor Site Manager)

Name: Sahlani/ HSE Name: Name:

Signature: Signature: Signature:

3. Request for Inspection

The Safety Improvements have been completed and you are requested to inspect the work / area
on at hours

Subcontractor Site Manager Name: Signature:

4. Confirmation of Result
This safety Non-conformity(ies) is(are):-
 LIFTED  REMAINS IN FORCE

Remarks:

Reviewed By: Approved By:

(HEC HSE Coordinator) (HEC HSE Manager)
Date: Name Juni Septariadi Date: Name S. Jeong
Sign.: Sign.:
Photo of HSE Non-conformity:

Photo of Corrective Action: