ie 1 ikea alin. She hoc g a «| tssue No. Date Sola Saudi Basic Industries Corporation 1 or 7 Se | ext Tasve | ‘i fo Da Service Purchase Requisition Form-3 Due esi To be filled by PR initiator / End User PR No.: 21642534 RFQ # ‘Work Description: Structural & Piping Fabrication Jobs A. BIDDER’S REQUIRED TECHNICAL DATA. ] GPS to: 1) Pass the required data to all contractor selected to participate in the RFQ 2) Obtain the required data and pass to PR initiator for evaluation and feedback oe Required ee Required | SN Item Description Yee | No | SN Item Description al No| 01 | 3 years recordablelost time injury data | | 06 | Risk Assessment for ofitical jobs." Mandatory 02 | Incident Rate for previous 3 years 07_| Waste disposel program. a ong term contractor should provide Other EHSS data to be obtained . 03 | annual Medical plan.” anasto 108 (specify) ea Provious experiance with SABIC afiatos Quaity assurance requirement for 4 | or other faciities en services (QA&QC plan) te Employees training and qualification ‘Short Term contractors “fit to work’ “| Mandatory | °5 | documentation * Mandatory | 10 | medical cenifcate, * “* *ifthere is manpower to be moblized to site Applicable for specific activities B. SABIC REQUIREMENTS (TO BE COMMUNICATED TO CONTRACTORS) 1. EHSS Requirements Paragraph Title Yes | No | Paragraph Tite yes | No ‘SHEMOS | Thiel Party EHSS Managenent | Mandatory | SHEM08.06 _| Lifing Equipment = ‘SHEN-08.01 | General EHSS Rules = ‘SHEM08.07 _| Hand Tools 'SHEN-08.03 _| Material Handling & Storage = SHEM-08.08 | Porsonal Protective Equipment |\— ‘SHEM-15 | Transportation Sofety ea 'SHEM-08.09 | Working at Height Le ‘SHEM.08.05 | Electrical Safety = 'SHEM-08.10_ | Work Permit ira SHEN 1a 7 _| IH Medical Check FT Others ‘Spec atta procadurensiuction 2. Is Fire/Flame Retardant/Resistant Clothing required? |\_|Yes No 3. Is special PPE’s required for this job? [Xf Yes[_| No IFYES, please specify _Weldi Ve z 4. Are there any Job Specific Hazards? [X}~Yes [_] No _Ifyes, lists the hazards. (Potential fires, explosive, toxic, or unique hazards related to the proposed work and the facility) Cove Dus CtEa) 3 we wo eadeey. Ee Provide attachment if required er Contractor Management System (CMS) /Solio Saudi Basic Industries Corporation ieaverrer rae Next Issue ~ | Service Purchase Requisition Form-3 ue lee 5. Is Emergency Medical Facilities required? [_|Yes [Xo a) b) Note: Attach extra sheets if required 6. Is Contractor equipment’ machineries required to be used in SABIC sites?. [U}vés [_] No If yes, list the equipment for inspection to be prepared by contractor. a) lacbene Grenada 4 fe Musy Kes tale gou Cutty b) o Uf C 7. Is Contractor temporary facilities/ portable building required? Dyes (Ene If yes, refere to SHEM-09 requirement. 8. Define Specific certification as required in contract/ work scope. a) Welder C, to b) 9. Special qualification of contractor employee's categories! discipline, if any? a) b) 10. On-site supervision of contractor employees: ‘A. Work Supervisor (1:20 ratio) {Full Time SABIC and SABIC Affiliates B. Safety officer (1:20 ratio) [|Full Time "ABIC and SABIC Affiliates 11. User shall select which high risk tasks are involved in this job. (Put Y Mark). Activities on Live Electrical Equipment () 10. Insulation Work Bolt Tensioning Activities 11. NDT Inspection & Radiography Testing Chemical Cleaning Activities O 12. online Leak Sealing Hazardous Chemical/Hazardous Waste [] 13 Repair / Cleaning Sewers Handling & Transportation. Confined Space Entry 0 14 Scaffolding Activities Critical/Heavy Lifting Operations Underwater Work Excavation Activities Welding Activities Hot Taps, Stoppling Other Hydro-Jetting Activities oo0000 0000 © @NOa soNa 12. Is kiok off meeting required? [U}¥es_ [_|No Contractor Management Svstem (CMS)~4;jL115| Saudi Basic industries Corporation == [= Rev.No | Date ; scat Reve | ae: Service Purchase Requisition Form: it a / Prepared by requestor: Abdulla A. Buhligah Signaturey_ poe Date: 31.10.2018, Approved by (End user Manager/Sr. Manager) Name: Jayanta K. Mohapatra Signature: Vet fate: 31.10.204 (Contractor shall go through all requirements mentioned in this form and enclose with contractor proposal submitted against REQ) (To be filled by the contractor during the bid submission) 13. Does contractor hire sub-contractor for proposed Job? OYes O No If yes; Main Contractor shall obtain permission as per Contractor Management System and local regulation Roles and Responsi ies of contractors (in case any deviations in the roles and respons y, please notify to concer user in written). All above requirements acknowledged by (Contractor Management) Name: Signature Date: Contractor Management Svstem (CMS)