Company:

HSE INSPECTION Date:

REPORT

Inspected By:

AREA/TASK DESCRIPTION: TIMESCALE CATEGORY CODES

1. Porto cabin 1 = Immediate

2. Machine area. 2 = 24 Hours

3. Mezzanine floor 3 = 3 Days

4 Painting section 4 = 7 Days

5 = As Stated

Item Area Cat Item Observed Action Required Action By Action

Confirmed

COMPANY REPRESENTITIVE TO CONFIRM THAT THE ITEMS IDENTIFIED ABOVE HAVE BEEN ACTIONED

Name: Signature: Date: