Instrument, Installation & Maintenance Co.

Job Safety Observation Report No: IMCO_JSO_12

P. O. Box 22803, Doha, Qatar
Tel no. 0974-466-79-10/23/24 REPORT Project Title: EPIC FOR POWER
SUPPLY TO DSSA & NWDH

Describe in detail the Job Safety Observation: (including scenarios and recommendations)
_________________________________________________________________________________________________
Date of Job Safety Observation: 27, August’ 07 Time of JSO: 08:45 am
Person Involved: ALL QAIG Workers Company Name: Qatar Al Atiyah
Nationality: Indian, Nepali & Bangladesh Badge Number: Sub Contractor
Location of Incident: 33kV sub station IMCO Worksite Supervisor: Mhd. Abdul Rahman

Brief Description of incident:

When the time that all workers of QAIG sub contractor of IMCO in 33kV are busy due to the installation of
beam slab for the 1st floor of the 33kV building the unwanted materials and tools are scattered on the floor
when the workers are working around the area. Beside on this scenario, the other workers also are walking
along to upper portion of beam slab. These unsafe conditions of the working area are possible to slip, trips and
fall of the workers.

Attach separate sheets if insufficient space; NOTE IMCO_FO_JSO_019a

Action Taken:
Immediately giving instruction to the worksite supervisor that his responsibility is to check the safe condition of
the working area and possible unsafe condition.

State actions taken to correct and prevent such occurrence: If closed what evidence have you to verify:
If still OPEN state measures for closure:

Recommendation;
1) Apply the 3A’s of safety, Awareness, Attitude and Action to protect workers safe.
2) Identify those hazards that cause you in slip, trip and fall.
3) To avoid trips, keep the pathways and work areas clean.
4) Properly store tools that aren’t use.
5) Never use a stairwell as a storage room and trash belongs in the trash bins.
6) Never, ever attempt to walk trough the beam slab that will cause you to accident.

Confirm if Job Safety Observation is Open or Closed

OPEN CLOSED

If closed sign: Safety Officer: I hereby confirm that the Job Safety Observation has been closed and corrective preventive
methods applied

Signature: Joel Vestal Date open: Date closed:

Reported By: Reviewed and Checked by HSE In-Charge ONLY:

Name: Joel Vestal Name: Francis E. Tan

Signature: Date: 27, Aug.’07 Signature: Date:

Designation: Safety Officer Confirm closure if applicable
Are their attachments
YES NO Closed: YES NO
Note: Form must be completed in all sections where possible; clear precise legible reporting must be made, ensure that any
attachments are correctly filled out and stabled or adequately clipped

Form Created: 16_January_07 IMCO_FO_JSO_019

Form revision # : 0