Project Name:

Safety Violation Notice Ref: GBC/HSE/

Employee
Name of Employee
ID/Emirates ID
Date: Time: Designation: Location:
Name of Company Name of Supervisor/foreman:
I understood and agreed to follow Health & Safety rules at workplace throughout the project completion and also I will be fully
responsible in case of any fine/warning issued under my name due to non-compliance of Project Health & Safety rules.
My signature is appended here.

Violation for Un-Safe Act / Un-safe Condition Details:

 Un-safe work at height
 Un-safe lifting procedure
 Un-safe working on edge
 Using Un-safe working platform
 Urinating at site
 Working on visit Visa
 Working plant/equipment Without TPC
 PPE’s non-compliance
 Using damaged electrical cable
 Sleeping non designated area
 Un-safe storage of material
 Poor housekeeping
 Working under influence of alcohol
 Misuse/damaged company property
Others Please Specify
 Working without HSE Induction
 Work permit not obtained
 Using damaged/unsafe power tools
 Smoking at non designated area
 Using Un-safe plant/equipment
 Non-compliance of permit requirements
 Theft Case

Name & Sign of Safety Officer_____________________________________________________________________________

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 SAFETY VIOLATION PENALTIES
Classification of Violation
Violation Committed Class 3 Class 2 Class 1
(Can lead to an injury or damaged to (Can lead to serious injury with lost (Can lead to fatality, permanent
property) time days) disability, or multiple serious
injury)
 Non-Compliance to H & S Plan 100 1000AED 5000AED
 Non-Compliance to Environmental 100 1000 5000
Plan
 Working on unsafe or untagged 100 1000 5000
scaffolding
Not Providing Safe working platform 100 1000 X 2 5000
 Using unsafe access and egress. 100 1000 5000
 Working without lifeline. 100 1000 x 2 5000
 Climbing on shutters without fall 100 1000 5000
protection
 Arguing with safety representative. 100 1000 5000
 Removal of edge protection without 100 1000 5000
PTW.
 Not protecting open Penetrations to 100 1000 5000
site standard
 Failure to follow PTW. 100 1000 5000
 Working on loose planks. 100 1000 5000
 Unsafe Method of deshuttering 100 1000 5000
 Unsafe Method of 100 1000 5000
erection/dismantling of scaffolding.
 Working on single planks while 100
erecting, dismantling, surveying 1000 5000
scaffold or temporary works.
 Climbing on ledgers. 100 1000 5000
 Working without leading edge 100 1000 5000
protection
 Working at height without full body 100 1000 x 2 5000
harness.
 Obstructing access and egress. 100 1000 5000
 Lack of competent supervision. 100 1000 5000
 Allowing unsafe work practice. 100 1000 5000
 Allowing to work in unsafe excavation. 100 1000 5000
 Dangerous Driving. 100 1000 5000
 Tampering with Safety/ Fire 100 1000 5000
Equipment
 Using uncertified lifting equipment. 100 1000 5000
 Working With Uncertified Operator 100 1000 5000
 Unsafe Lifting Activity 100 1000 5000
 Entering/Working on confined Space 100 1000 5000
without Permit.
 Radiography Testing Without Permit 100 1000 5000
 Carrying out LOTO without Permit 100 1000 5000
 Endangering other person. 100 1000 5000
 Working without method 100 1000 5000
statement/Risk Assessment.
 Not adhering to method 100 1000 5000
statement/Risk Assessment.
 Working without task related PPE. 100 1000 5000
 Allowing people to work without 100 1000 5000
induction.
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 Not Having Sufficient Safety Officers 100 1000 5000
as Per Legal Requirement
 Not adhering to a reasonable directive 100 1000 5000
from a member of HSE team.
 Non Compliance to Safety Standard 100 1000 5000
 Sleeping on undesignated area 100 1000 5000
 Fight on Site 500 5000 5000
 Breach of Housekeeping 100 1000 5000
 Smoking on Site 100 1000 5000
 Urinating or 100
passing/discharging/excreting faeces 1000 5000
on site.
 Non-Attendance at Safety Walks 100 1000 5000
 Deviation from the Municipality 100 1000 5000
legislation
 Non-Attendance at Safety Meetings 100 1000 5000
 Others 100 1000 5000
 Others 100 1000 5000
 Others 100 1000 5000

 Repeated Violation will lead to doubling the penalty

 Accumulation of 3, Class 3 violation by an operative will lead to removal of operative at site.
 Accumulation of 2 Class 2 violation by an operative will lead to removal of operative at site.
 Any Class 1 offence committed will lead to removal of the operative at site.
 Urinating or Passing/discharging/excreting faeces on site are punishable by removal from site.

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