P. O. Box: 261032, Dubai, U.A.E Tel: 04 – 2821182, Fax: 04 - 2820215 E-mail: dynatechsafety@eim.ae

SAFETY INSPECTION REPORT

Contractor: Date:

Project :

Description of Un-safe Condition, Un-safe Acts: Action by / Remarks

Safety Personnel: Name: Signature:Cc: Manager In-charge Form # DSSS/S/02 - 1

Details of Corrective action taken:

P. O. Box: 261032, Dubai, U.A.E Tel: 04 – 2821182, Fax: 04 - 2820215 E-mail: dynatechsafety@eim.ae

Form# DSSS/S/003 - Corrective / preventive Action enclosed : YES / NO

Manager In-charge: Signature: Date:Cc: Safety Department

Verification of Corrective Action:

Implemented: YES / NO Effective / Acceptable: YES / NO

Comments:

Safety Personnel: Name: Signature: Date:

Cc: Manager In-charge Form#: DSSS/S/02 - 2