Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

HSE Violation Slip

Site
Site: Date/Time:
Ref.No.

Name: Designation:

Code No: Company: LCQ

Line Manager/
Area/ Location:
Immediate Supv.

Offense Description Punishment Schedule


Not wearing helmet
Not wearing safety shoes/ protective footwear Occurrence
Not wearing gloves where needed First
Welding without adequate screening to avoid arc eye Second
Riding on plant as other than the driver Third
Entering exclusion zones
Not using designated/ pedestrian pathways
Not using designated vehicular routes Employee
Not depositing rubbish in receptacle provided Written Warning
Operating without PTW Reorientation
Operating beyond scope of PTW 1 day wage fine
Operating with outdated PTW 2 days wage fine
Issuing false PTW 3 days wage fine
Not wearing eye protection/ face shield where needed 5 days wage fine
Working without attachment of lanyard where needed 7 days wage fine
Not making use of toilet facilities provided Dismissal
Tampering with safety equipment
Unauthorized alteration of scaffolds
Working on prescribed works without risk assessment in place Line Manager
Not adopting mitigation measures of risk assessment Written Warning
Deliberate dropping of objects from height Reorientation
Ignoring the legitimate instructions of safety personnel 1 day wage fine
Falsification of safety records 2 days wage fine
Not maintaining safety records 3 days wage fine
Not providing PPE to personnel where needed 5 days wage fine
Driving on site above speed limit in place 7 days wage fine
Unauthorized/ uncertified use of plant or equipment Dismissal
Allowing unauthorized/ uncertified use of plant or equipment
Using unchecked lifting tackle
Improper slinging of loads
Working in un-shored/ unbenched excavations
Use of damaged/ improvised ladders
Operating defective plant
Inadequate housekeeping
Others

Endorsed By:
(HSE Manager/HSE In-Charge)
Issued By:
(Site HSE Officer) Approved By:
(Project Director/Manager)

Distribution: Human Capital, Employee, File

PP-HSE-VL-12

You might also like