HSE-F-006-VIolation Notice

Safety Violation Notice REV. 01

PROJECT/LOCATION DATE:
Offender - (Name) Designation: Company:

Subcontractor / Supplier:

Section I DETAILS OF NON-COMPLIANCE / SAFETY VIOLATION / BREACH

☐ Failing to follow Safe work procedures / Risk

☐ Working on site without HSE Induction /
Assessment Method Statement not communicated, Daily
not Submitting the valid identification certification /
Failing to follow Local Legislation for HSE.
TBT&PTW not obtained prior to commence the work

☐ Use of cranes and lifting appliances without valid 3rd ☐ Endangering life and safety of himself or other person
party inspection / test certificate. / Failure to obtain Lifting by creating unsafe conditions or hazards, eg working on
Unsafe scaffolding incomplete scaffolding,
permit or not followed the precautions needed Removing floor opening / handrails / edge protection
☐ Working over 2 Mtr above without fall prevention or
arrestors / working without proper platforms/ladders ☐ Failure to adorn the necessary PPE or misuse the PPE
/Lifeline/ Full body harness / Handrails. provided

☐ Adequate precautions not taken while handling/storage

transporting/use of COSHH/Gas cylinders/Diesel/ Petrol, ☐ Failure to conduct proper housekeeping or stack
materials in an unsafe manner

☐ Electrical Tools / Equipment used without its protective ☐ Operating plant / machinery without Licence / 3rd party
guards and other safety controls/damaged wire or sockets. certification / wrongly parked or repairing onsite.

☐ Smoking at prohibited or non-authorized places

☐ Wilful damage to or abuse of safety devices or equipments
Eating or Sleeping at workplace in undesignated area
Horseplay whilst at work.
☐ Other specify: -

Section II REMEDIAL ACTION PROPOSED / TAKEN TO CLOSE OUT NON-COMPLIANCE

Section III DISCIPLINARY ACTION PROPOSED / TAKEN

Consider this should be your: - First ☐ Second ☐ Last Warning ☐

Note:
 Issue of 2nd/3rd Safety Warning Notices followed shall result in the issue of a fine /termination from site subject to
Managements approval.
 I acknowledge receiving explanation and counselling for my actions.
 By signing this document, I acknowledge that I understand the reason for the issuance of this disciplinary action.

Name of Offender: Work in charge: Duty Engineer:

HSE Project Manager

Distribution: - ☐ Subcontractor ☐ Offender ☐ HR Dept. ☐ Commercial Dept. (Penalty Case) ☐ HSE File
Note: Details of Penalty are given on Reverse

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 FINE
SR. NO SAFETY VIOLATION REMARKS
(DHS)
FINES TO COMPANY
To in charge
1 Working on site without HSE Induction / not Submitting the valid identification certification. 500
/Company
Allowing Workers over 2 Mtr above without fall prevention or arrestors / working without proper fall up to 5000 as per
2 1000
protection and arrestor system. condition
Hot works, working in the shafts /roofs and confined space entry without permit (PTW) /recommended
3 1000 up to 2500 as per
precautions not taken
condition
Failure to possess and/or follow PTW system / PTW not obtained / Procedures of PTW not followed.
4 500
(except Serial 3 above)
Tools / Equipment not provided / used defective / Use of electrical installations in an unsafe condition up to 2500 as per
5 1000
or electrocution of any person condition

Storing / transporting / handling / use of hazardous substances / gas cylinders / chemicals / diesels / up to 5000 as per
6 1000
petrol / thinner, etc. in unsafe condition. condition
Performing critical activities without method statement / risk assessment or M.S. and R.A. are not
7 addressed to the executing personnel / Executing the job contrary to Method Statement / Risk 1000 up to 5000 as per
Assessment. condition
Endangering life and safety of himself or other person by creating unsafe conditions or hazards, e.g.
8 working on Unsafe scaffolding incomplete scaffolding, Removing floor opening / handrails / edge 1000 up to 5000 as per
protection condition
Person falling or working from height of more than 2m without fall prevention or arrest / Worked up to 5000 as per
9 1000
without proper working platform / Lifeline / Full body safety harness / Handrails condition

Operating plant / machinery without Licence / 3rd party certification / Overturning of any mobile plant, up to 5000 as per
10 1000
equipment or vehicle on site. condition
up to 5000 as per
11 Allowing the collapse of any scaffolding, temporary works or excavation. 1000
condition

12 Having not provided with necessary PPE or misuse the PPE provided 500 Per issue reported

13 Failing to provide required supervision for task 1000

Use of cranes and lifting appliances without valid 3rd party inspection / test certificate. / Failure to up to 5000 as per
14 1000
obtain Lifting permit or not followed the precautions needed condition
Failure to maintain acceptable level of housekeeping / Working in untidy area / failing to maintain a up to 5000 as per
15 1000
safe working environment / Failing to control waste collection and disposal. condition

FINES TO FOREMAN / SUPERVISOR / INDIVIDUAL

100/ 200/ To Foreman /
1 Removal of Guardrails / Floor protection and leaving the place in unsafe condition
Removal Company.
Hot works (Welding, Cutting, grinding), failing to follow procedures as stipulated in the PTW. Working To Foreman /
2 100 / 200
without permit in the permit area Company

3 Misuse of temporary electric / use of defective or unsafe or substandard tools and cables 100 / 200 To Foreman /
Company
To Foreman /
4 Smoking on site 250
Company
To Foreman /
5 Eating on site 100
Company
To Foreman /
6 Failing to wear the required PPE 150 / 200
Company
7 Working at the edge of the floor in unsafe condition 150/ 200 To Foreman /
Company
To Driver/
8 Speeding on site / failing to make use of safety belt / failing to follow road rules 100
Company
To Driver/
9 Parking vehicles on site access roads causing obstruction 100
Company
Working outside guardrails without safety harness / failing to use full body safety harness when 150/ 200/ To Foreman /
10
working in elevated position. Removal Company
To Foreman /
11 Working on crane, hoist without safety harness / without permit 200
Company
150 / 200/ To Foreman /
12 Precautions not taken as required / As per Risk Assessment
Removal Company
To in charge
13 Sleeping or resting on site other than designated rest area 200
/Company
To Foreman /
14 Working on unsafe / red tagged / substandard scaffolding 150 / 200
Company
200 / To in charge
15 Urinating smoking or spitting tobacco on site other than in toilets provided
Removal /Company

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