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Monthly Safety Zone Report

Zone- 1 : Boiler Stage Month – May2023


Zone Leaders- ….. Zone Members-
1.
2.
3.

Sl No Particulars Nos
1 No of Visits conducted in period with Zone
Members
2 Nos of Observations/Deviations Reported
3 Nos of Observations/Deviations Closed
4 Nos of Observations/Deviations Pending
5 No of Housekeeping / Mass Housekeeping
drives (Date& time Stamped Pics @ Table No1)
6 Actions/Initiatives taken to make Zone Safe
7

Critical Observations Pics(Time&date Stamped) along with Notification Nos


Pic 1 Before Pic 2 After
Sap Safety Notification No

Pic 1 Before Pending


Sap Safety Notification No Dept responsible
Pending for .. Nos of days

Declaration for Zone Safe: It is declared that we have identified all


Hazards in my Safety Zone and taken action / expedited with the
responsible department to eliminate the identified Hazards and my Zone
is SAFE.

Name & Signature


Copy to : GM(O&M)
CC: Safety Department

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