Project: U P G R A D E S E C U R I T Y F A C I L I T I E S E A S T W E S T P U M P S T A T I O N S Week No.
Exact Work Location: Date:
Task: Time:
Ite Finding{s) or Positive Unsafe Act Responsible Corrective Action to be Taken Target Actual
m Observation /Unsafe Supervisor Completion Completion
No. Condition/ /Foreman with Date Date
Near Miss signature
Remarks {if any):
Near Misses, Unsafe Act and Unsafe condition to be recorded in weekly HSE statistics report.
HSE Department Manager: Date:
Action Tracking Register