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UNITED INDUSTRIAL SERVICES CO LLC

SAFETY DEFAULT NOTICE


PROJECT : LOCATION :
NOTICE NO: Date & Time
Defaulter's Name : Designation:

Name of Immediate Supervisor/Foreman :


Brief description of default :

Previous default if any [ Yes /No ]

Recommended Action : (* Strike out if not applicable )


4 Stop the job and correct default
4 Counsel / Warn the defaulter
4 Cut a days salary of defaulter / staff concerned
4 Others:
Issued by Name Signature Date

UNISCO Safety Officer/Supervisor

CC:
GM
Project Manger Individual Sign
Project Engineer

UNISCO[PF]HSE-05 Rev-00 15/07/16

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