China Construction (South Pacific) Development Co Pte Ltd
HSE ADMINISTRATIVE CHARGE FORM
Form No: HSEMS - 06 – 02A
(A) NOTIFICATION OF HSE VIOLATION(S) TO RELEVANT PARTIES
Project:
BUKIT BATOK N4 C24 & C25
LAU KAH SOON
Attention:
cc to Manpower / Finance / etc.
(Name of Sub-Con. Director / Manager or Main Con. Foreman / Worker)
Name of Head Office Department
ZHAO YANG
Name of Company:
Manager / Representative:
(State NA if sub-contractor is not penalized)
Name of Head Office Manager / Rep.
(B) HSE VIOLATION(S) & ADMINISTRATIVE CHARGE(S)
Admin Charge Ref. No:
Admin Charges To:
CCDC/BBN4C24&C25/2023/123
Individual / Company
(Delete as appropriate)
Name of Offender(s):
Date of Offence:
20/12/2023
ZHAO YANG
(Name of Worker(s) Responsible for HSE Violation)
Scope of Works / Trade:
GROUND ANCHOR
WORK
Work Permit No(s):
Please be informed that a penalty administrative charge of
$300/against you / your company for the following HSE violation(s):
S / NO
01
(OP7)
DESCRIPTION OF HSE VIOLATION WITH ATTACHED PHOTO NO
Workgroups and sub-contractors shall comply with orders issued by
the safety personnel of the site (Project Manager, WSH Officer,
WSH Coordinator, etc.).
(if applicable)
is imposed
ADMIN CHARGE(S)
$300
施工班组及分包应执行现场安全责任人签发的指令（项目经理、安全官
、
安全协调官等
Prepared & Proposed By (WSHO/ WSHC /ECO):
.
Iszwan /
Jeff Shao 20. 12.2023
/ 20.12 .2023
Name / Signature / Date
Name / Signature / Date
Acknowledged & Processed By:
Site QS (if applicable)
Finance Dept (if applicable)
Manpower Dept (if applicable)
Page 1 of 2
China Construction (South Pacific) Development Co Pte Ltd
CCDC/BBN4C24&C25/2023/123
Site Observation – Workforce not using proper access choose to take short cut by climbing up the
slope.(Taken by MOM officer)
Page 2 of 2