Project: U P G R A D E S E C U R I T Y F A C I L I T I E S E A S T W E S T P U M P S T A T I O N S Week No.

Exact Work Location: Date:

Task: Time:
Ite Finding{s) or Positive Unsafe Act Responsible Corrective Action to be Taken Target Actual
m Observation /Unsafe Supervisor Completion Completion
No. Condition/ /Foreman with Date Date
Near Miss signature

Remarks {if any):

Near Misses, Unsafe Act and Unsafe condition to be recorded in weekly HSE statistics report.
HSE Department Manager: Date:

Action Tracking Register