QASSIM-1 IPP Project

SAFETY VIOLATOR WARNING LETTER

NAME : SIGNATURE :

SECTION : JOB TITLE :

I.D BADGE NO : COMPANY & PROJECT :

DATE : TIME : LOCATION :

Warning Reason(s) Guidelines Tick Here

Minors Offences

Repetitive Minors Offences.

No wearing Specifics PPEs.

Parking in not authorized area.

No respect of wearing Basics PPEs (Helmet, Safety glasses, safety shoes, safety vest, gloves).

Workers transportation (Excess of passengers on workers transports).

Serious Offences Sleeping or Eating on site.

(Yellow Card + Crossing Barriers/Short cut.

Training Smoking in unauthorized areas.

Refreshment) Run, jump and horse play (Chasing, pushing, throwing tools or materials, climbing on or under forklift forks or moving crane

parts, practical jokes like "hiding" someone's PPE) depending on the action can be considered as Serious Offences.

Using non inspected material & Tools (Non color coded, Handmade, unsafe,,,).
Speeding/Using phone & driving/No using of safety belt.
Working alone.
Working without induction or Specific Training.
Unsafe method of work resulting from poor Safety Training & knowledge.

Repetitive Serious Offences.

Unsafe method of work resulting from the non-interest of respecting safety rules in site.

Working underneath/Under load.

Do not meet the indications of HSE personnel or refuse to deliver access badge.
Supervisor/Forman forcing workers to perform unsafe work.
Very Serious
Violation of PTW system (Working without permit, not proper fulfilled, Violation of lifting Plan).
Offences (Red
Scaffolding modification by unauthorized personnel or Scaff tag Signed by unauthorized person.
Card + Work at Heights without Fall Protection including Excavations (Harness, barricades, lifeli ne, proper access….).

Temporary or Unauthorized Removal of Safety Tags (Scaff. tag, warning signs, LOTO tag, inspection sticker, color-coding, etc…

Use of cell phone for Machinery operator, rigger, flagman during driving or operations.
Final Dismissal
Breach of Control access, deliberate phishing (accessed with another worker).
from Site)
Testing positive for drug or alcohol while on duty.

Fighting/Aggressions/Serious assault.
Stealing.
Open fire on site.
Unsafe act that caused harm to people or gross damaged to property.

Driving without Permit/license (including machinery).

Other Violation

Issued By
Name & Signature Date & Time Company &Job Title

Dismissal for 01 Dismissal for 03 Dismissal for 01

Penalty Proposed Induction or specific Days days Week Dismissal for 03 Weeks Final

Acknowledged By Approved By Agreed by

Department Manager EPC Contractor HSEM Project Director