PROJECT: EMPLOYER: LTA/SITE CONTRACTOR:

UNDP ENGINEER:
MERP Program

SAFETY PENALTY NOTICE

From: To:
SPN ref: Schedule ref:
Contractor/Area/Year/SPN/Trade/Seq.#Rev#
Area: Specification ref:
Location: BOQ division ref:
Date: Material Submittal ref:
For Engineer’s Use:
1. Description of Non Conformity
Subject : ------------------------------------------------------------
Description :

No. of attached photos --------.

Please refer to attached safety list items
2. You are requested to take necessary action to remedy the violation within ----- Hours

Site Engineer’s Comments:

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Name: Signature: Date:
For Contractor’s Use:
3. Remedial Action Taken By the Contractor:
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---------------

Name: Signature: Date:

For Site Engineer’s Use:
4. Site Engineer Comments: Status
------------------------------------------------------------------------------------------------- A □
------------------------------------------------------------------------------------------------- AWC □
------------------------------------------------------------------------------------------------- RR □
-------------------------------------------------------------------------------------------------
------------------------ REJ □
Name: Signature: Date:

UNDP-MERP Program
PROJECT: EMPLOYER: LTA/SITE CONTRACTOR:
UNDP ENGINEER:
MERP Program

5. Inspection Work remedied as per Engineer’s Comments. Status

Engineer’s A □
Explanation:------------------------------------------------------------------------------------ AWC □
--------------------------------------------------------------------------------------------------- RR □
---------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------- REJ □
-------------------------------------------
Name: Signature: Date:

Purpose of Distribution Attachment(s) Receipt Info

Attachment
Type of Receipt Info
Sent To Acti No (s)
Attachment(s
on Action Received Dat
Yes No ) Signature
By e

Serial Grade or Associated

Description
# Violation Penalty
Medical Services
1 first aid provision
2 emergency transportation
direct access to insurance's claims papers and to nearest
3
hospitals list, addresses and telephone numbers
Personal Protective Equipment
protective equipment in all operations subject to exposure to
4
hazardous conditions
5 helmets, safety boots
6 eyes, hands, face, ear and respiratory protection
7 safety belts
8 red or orange warnings garments for flagmen
red or orange warnings garments reflectorized for flagmen
9
working at night
Material Storage and Handling
10 appropriate handling of flammable and combustible

UNDP-MERP Program
PROJECT: EMPLOYER: LTA/SITE CONTRACTOR:
UNDP ENGINEER:
MERP Program

materials
11 material safety data sheet for each hazardous material
12 appropriate disposal of waste material
Electrical Provision
13 suitable circuit outlets and interrupters
14 grounding of equipment
15 lockout and tagging of circuits
16 proper and safe routing of cables
17 illumination of site
Working Platform
Permanent and continuous path, clear from circuits,
18
equipment and enclosures.
19 site cleaning
20 handrails and railings for stairs
guardrails to every open sided platform (including but not
21 limited to openings, shafts, roofs, ramps, walkways…) with
protective nets to prevent materials from falling beneath
Catch platform below the working area of roofs more than
22
16 feet from the ground.
Scaffolding (load capacity, stability, distribution, type,
23
support…)
24 Check list for scaffolding, ladders, guardrails…
25 safety nets and warning lines in hazardous areas
26 prohibit workers from riding concrete buckets
27 proper ventilation of confined areas
28 all safety signage

UNDP-MERP Program