Instrument, Installation & Maintenance Co.

Job Safety Observation Report No: IMCO_JSO_25

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: 09 Sept.’ 07 Time of JSO: 09:00 pm
Person Involved: Sita Ram Rai and Soman Company Name: Qatar Al Atiyah
Nationality: Nepali Badge Number: Sub Contractor
Location of Incident: 33kV sub station IMCO Worksite Supervisor: Mhd. Abdul Rahman

Brief Description of incident:

At 9:00 pm during concrete pouring for the slab in 1st floor at 33kV substation, Sita Ram Rai Civil Supervisor
and Soman QA/QC Engineer of QAIG sub contractor of IMCO has given instruction to their workers to
dropdown the vibrator machine with the elevation of 3 meters from the 1 st floor up to the ground level by
manual handling only.

Attach separate sheets if insufficient space; NOTE IMCO_FO_JSO_019a

Action Taken:
Immediately stop them for the unsafe instruction of this Supervisor and QA/QC Engineer which is possible to
accident when the unbalanced unloading of machine and strike to the workers underneath.

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) Worksite supervisor should aware always and correct the unsafe behaviors of his workers and not the supervisor
are doing the unsafe acts for their workers.
2) Provide nylon rope for unloading of vibrator machine to prevent accident.
3) Identify those hazards while unloading materials.
4) Ensure that the Safety Rules and Regulation are adhered to and that relevant Safety Precaution is taken.

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: Roger P. Drilon Date open: Date closed:

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

Name: Roger P. Drilon Name: Francis E. Tan

Signature: Date: 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