SAFETY MEMO : PERSONAL SH Form SM 001

No.
PROTECTIVE EQUIPMENT
Revision 00
Project: CADANGAN MENDIRIKAN MADRASAH Issue Date 20.08.04
TAHFIZ MIFTAHUL ULUM DI ATAS LOT 5649, 2193 Page 1 of 1
& 2194, BATU 1, JALAN KUARI SUNGAI LONG, IQTIQAD MAJU SDN BHD
KAMPUNG SUNGAI SERAI, DAERAH HULU
LANGAT, MUKIM HULU LANGAT, SELANGOR
DARUL EHSAN

Safety Memo No. 01/ /

To : …………………………………………………….. Date:
…………………

Subject : Site Safety – Safety Personal Protection Equipment

We refer to our site inspection on ……………………..at …………. am / pm by our Safety and Health Officer
at;

Section/ Zone : ……………………………… Chainage/ Level: ……………………………

Location: ………………………………

When your workers were engaged in the ……………………………………………… operation, and noted that
you had failed to:

provide the following safety equipment to the workers under your supervision;
ensure that strict utilization of the following safety equipment by the workers under your
supervision;
Complete and return the safety equipment issue duly signed by all the workers under your
supervision;

Being;

Safety helmet
Fall protection
-Safety harness
-Anchorage for safety harness
-Independent life line
Eye protection
Hearing protection
Respiration protection
Others

………………………………
Safety and Health Officer

Name :

Time :
SAFETY MEMO : PERSONAL SH Form SM 001
No.
PROTECTIVE EQUIPMENT
Revision 00
Project: CADANGAN MENDIRIKAN MADRASAH Issue Date 20.08.04
TAHFIZ MIFTAHUL ULUM DI ATAS LOT 5649, 2193 Page 1 of 1
& 2194, BATU 1, JALAN KUARI SUNGAI LONG, IQTIQAD MAJU SDN BHD
KAMPUNG SUNGAI SERAI, DAERAH HULU
LANGAT, MUKIM HULU LANGAT, SELANGOR
DARUL EHSAN

Date :