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EPCC-20 PACKAGE – ARAB MIX CRUDE OIL PIPELINE

Format No: HSE - 25


SAFETY VIOLATION REPORT Rev: 0 Page 1 of 1

Location: Date:

Activity: Foreman / Supervisor.

Name of Worker / Staff (Violator); Contractor;

Description of Violation:

After frequent instruction, which may lead to accident. So, you are instructed not to violate safety rule, otherwise
you will be responsible for same and penalized accordingly.

Penalty of Rs……………………………………………… Penalty will be deducted from your monthly


bill/payment.

Prepared BY: Received by Verified BY:

Safety Dept. (Person) RCM

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