HSE NON-CONFORMITY REPORT

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

Clarifier D Time: 16.41 HEC-HSE-NCR-

Department/Subcontractor: Commissioning /IPTC PTW No.:

Description of Work in Progress:

1. Details of Non-conformity
- Cable lay exposed on the ground crossing the access for worker activity

2. Action to be taken
The following Safety Improvements shall be completed by Date: Time:
- Arrange the cable by hung up minimum 2 M from the ground

Notice Issued By: Acknowledged By: Verified By:

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

Name: Zukhruf B/ 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: