DEPARTMENT

DATE :

FOR :

THRU :

SUBJECT : SAFETY MONITORING REPORT

TIME / DATE

REPORT DATE LOCATIO RECOMMENDATION

RECOGNIZED HAZARDS STATUS
CODE TIME N ACTIONS TAKEN
10.29.13 / 3rd floor Damaged louver and open panel. At (TIME) properly coordinated to CLOSED
022H VIP EE _____ of engineering dept.
room regarding the concern
F. Yabut
N. BEFORE AFTER
Lubuguin