SAFETY VIOLATION REPORT

AND CORRECTIVE ACTION

Project: Lusail stadium precinct Date Prepared:31-03-2018

Location: Stadium-Zone-5 SVR No.
DESCRIPTION OF DEFICIENCY:
Violation of site safety Rules. Unauthorised erection of working platform(Unsafe).

CAUSE OF NON-CONFORMANCE:
Unauthorized erection of working platform between Doka Rebar Access scaffold and Doka D2 frames scaffolds for
slab without coordinating or communicating with DOKA competent person. Further more he allowed employees to
working on unsafe uninspected platform.

PROPOSED CORRECTION: Proposed Completion Date: 31-03-2018

1) Stop the activity immediately and instructed to dismantle the unsafe platform.
2) Instructed to the supervisor to coordinate with Doka & D2 competent personals.

PROPOSED CORRECTIVE ACTION: Proposed Completion Date: 31-03-2018

1) Re induction / Internal training.
2) Disciplinary action to be taken. (written warning with access card punched)

ISSUED BY: ISSUED TO: EVALUATED BY:

Name: HS Department Sonu Vishwakarma Shanavas S.

Position: Scaffolding Supervisor Asst. HS Manager The proposed actions

are:
☐Acceptable
Signature: ☐Not Acceptable

Date: 01-04-2018

COMPLETION OF DEFINED ACTIONS:

Actual Completion Date01-04-2018
Days elapsed from detection to actual completion of action:

HS INSPECTION REQUESTED BY:

I hereby confirm that the above defined actions have been completed
and thereby request an HSE Officer's Inspection.

Name: Ashafa Olajide

Position: HS Officer

Signature:

Date:

VERIFYING HS MANAGER: RECEIVING PROJECT MANAGER:

I hereby acknowledge that the measures stated above have I hereby acknowledge that I have received a complete
been checked and verified to be appropriate and copy of this report.
satisfactory.
Name: Eugene Okosun Name:

Position: Project HS Manager Position:

Signature:
Signature:
Date: Date

HBK-CRCC JV-HS-FRM-00062 Rev 0 Page 1 of 1 8-Nov-17