HSE OBSERVATION REPORT
CINQO CONTRACTING
Attention to: PROJECT:
DATE & TIME:
HSE OFFICER:
PHOTOS HAZ HAZ RESP. ACTUAL
CLOSED /
ITEM CAT COD LOCATION** OBSERVATION PERSON REMEDIAL ACTION TAKEN COMPL.
OPEN
EG* E SIGN DATE
1
HAZARD SEVERITY TIME TO RECTIFY
RESPONSIBLE ENGINEE : Mr Jerald Isturis DATE: 5/10/2023
AA IMMEDIATELY STOP WORK & RECTIFY
A MAJOR SAME DAY
B SERIOUS WITHIN 48 HOURS HSE COMMENTS:
C NOT ACCEPTABLE WITHIN 4 DAYS
HSE OBSERVATION REPORT
CINQO CONTRACTING
HSE
* Choose numbers from the hazard categories listed on the back side
Officer:
** Choose number from locations listed on the back side
Hazard Category
1 21 Slip / Trip / Fall 41 Welfare Facilities (Mess Hall, Toilets etc.)
Work at Height
2 Scaffolding 22 Hot Surfaces 42 Defective Machinery & Equipment
3 Protection from Falling 23 Sharp and Jagged Objects 43 Lack of Supervision
4 Ladder 24 Nearby Work 44 Stockpiling
5 Falling Objects 25 Hydro Testing 45 Fire Prevention
6 Electricity 26 Pressurized Systems 46 Emergency Preparedness
7 Powered Hand Tools 27 Exposed Man-Holes & Incomplete Structures 47 Warning Signs
8 Proximity to Electrical Switchboards (400V+) 28 Working with Chemicals 48 Waste Management
9 Use of Improper Hand Tools 29 Vermin, Pests, Disease 49 Others (specify)
10 Lifting Operations 30 Vibration (impact hammers and compactors)
11 Transport & Moving Equipment 31 Noise
12 Excavation & Backfilling 32 Oxygen Deficient Atmosphere & Inert Gases
13 Confined Space 33 Radiation & X-Ray
14 Poor Lighting / Low Visibility 34 Working Near Water
15 Weather Conditions 35 Spills/ Leaks
16 Dust 36 Housekeeping
17 Hot Work / Fire 37 Access/ Egress
18 Grinding 38 Personal Protective Equipment PPE
19 Abrasive Blasting 39 Permit to Work System
20 Manual Handling 40 Rotating Equipment / Pinch Points