‫م‬.‫م‬.

‫عـــزعــمـــان الهـنـدســيـة ش‬
IZZ OMAN ENGINEERING LLC
IZZ-HSEF-15, REV-1

HSE OBSERVATION REPORT

To:- Report From:-

Copy :- Date / Time:-
Division:- Location:-
AREA OF OBSERVATION ( on appropriate box):-
PERSONAL PROTECTIVE EQUIPMENT LIFTING EQUIPMENT / TACKLES
HOUSE KEEPING / MATERIAL STACKING EARTHMOVING EQUIPMENT
MANUAL MATERIAL HANDLING CHEMICAL STORAGE / HANDLING
MECHANICAL MATERIAL HANDLING VEHICLE / DRIVING
SCAFFOLDING / LADDER WELDING / GAS CUTTING OPERATION
WORKING AT HEIGHTS PRESSURE TESTING (Hydro / Pneumatic)
WORK PERMIT GRIT BLASTING / PAINTING
HAND TOOLS OPERATING PLANT / MACHINERY
ELECTRICAL EQUIPMENT / HAND TOOLS / CABLE CONFINED SPACE
EXCAVATION / MAN HOLE / SLAB OPENING PORTABLE DG SET
SHUTTERING / REBAR WORKS / CONCRETING OTHER ITEMS (Health & Hygienic)

Description of the Observation:-

Recommendation for Corrective Action:-

Recommended Close Out Date:-

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Corrective Action Taken (To be filled by the Engineer / Supervisor & Return to HSE Dept. IZZ OMAN) :-
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
________________________________________________________ Action Close Out Date:- ___________________________

Name of Action Party____________________________________ Signature: - _____________________________

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Name & Sign of the Observer: - Date:-