safety breach notice

LUSAIL DEVELOPMENT SAFETY TEAM

SSP01/F03 – Safety Breach Notice

Lusail Development Safety Team Revision: 0 SSP01/F03 Date : 05/01/07Issue No: 01 Page/s : of 3

Prepared and Issued by:

James Anderson, Senior Safety Manager, Lusail Development Safety Team

Reviewed by:

William Street, Senior Project Manager, Lusail Development Project

Authorised by:

Hazim Alsadek, VP, Engineer, Lusail Development Project Revision History:

Revision Date Description

SAFETY BREACH NOTICESSP01/F03




URGENT ACTION REQUIRED

Issued to Project/Construction Manager:

Issued to (company):

Date of Issue:

Issued By:

Please be advised that at …………………….am/pm today at Location……………your employees were observed placing themselves and others at risk contrary to H&S legislation and good practice. Details………………………………………………………………………………………… ………………………………………………………………………………………………... …………………………………………………………………………………………………

The person(s) involved will NOT be permitted to continue working on site pending your response.

The person(s) involved will be permitted to continue working on site pending your response.

Work HAS BEEN stopped in the area where the safety breach was observed pending your response.

Please respond to this Safety Breach Notice involving your employee(s) within 24 hours by checking one or more of the boxes below. The reason the incident occurred was:- Suitable equipment / PPE was not provided for the task being performed.

Adequate training for the task was not provided.

Adequate supervision was not provided.

The task being undertaken was not contained in the company safe System of Work / Permit/ Procedure.

The person(s) concerned were working contrary to Good Practice / Instructions or Direction.

Other (please state) ……………………………………………………………. …………………………………………………………………………………………………. …………………………………………………………………………………………............




Please be advised that pending your urgent identification of the reason the above breach occurred, and your strategy for preventing a reoccurrence any similar incident involving your employees will result in Lusail Development Safety Team ordering an immediate cessation of the work task involved until further notice.

You are further advised that in accordance with recommendations by Lusail Development Safety Team, you are requested to conduct toolbox talk meetings with your employees and sub-contractors to advise them of the prevention strategy developed by the company and provide Lusail Development Safety Team with a record of the toolbox talk.

Include a clear description of how you intend to prevent a recurrence in the space provided.

A recurrence of this incident will be prevented by the company by carrying out the following:

Signed by: …………………………………………………………………………………………

Project/Construction Manager: ……………………………………………………………………………………..

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

safety breach notice

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