JIGCC PROJECT- UTILITIES &

02250
COMMON AREA- PACKAGE 5

INTERFACE WORK PERMIT PAGE 1 OF 1

02250-00-091-PD-0013-tmp17 REV.: 01

Permit No.:
12/14/2019 12/14/2019 19/14/2019
Date: Time
6:00 AM Work Start Date: Expiration Date: _
:

Work Description / Area.

1. high flow pump motor testing oily water A10-GM-0002A/B/C

2. Tick the items needed for this work.

Barricades Warning Signs Fire Extinguisher Tools inspected No slip, trip and fall hazard LOTO required
Spark Containment provided Combustible and flammables removed Sewer Openings covered Cables routed overhead
Standard PPE (Safety helmets, shoes, glasses) Full body harness Respiratory protection Hand gloves
Face Shield Others (Specify)

3. Check for the following conditions, if required.

DWG/Layout/Marked Plot plan Method of statement JSA/RA MoM Fire watch required Safety training
Adequate lighting Tool box talk Scaffolding Stand-by man
PWT: TR Road Closure Permit TR Excavation Permit Otherwise, use TR countersigned Contractor Permit

4. List any additional precautions or Attachments:

5. APPROVALS:
Name Phone No. Date Signature Remarks

Other Contractor
Representative (OCR)
TR Area Manager
(TRAM):
Disciplines (TR)
if affected:
-Piping

-Civil

-E&I
-Equipment /
others
HSE Area Spt (TR)

HSE Site Manager (TR)

Site Manager (TR)

6. PERMIT CLOSURE
Date: Time:
Work is completed Work area has been cleaned & material, tools, equipment & arrangement done LOTO removed
Other Contractor Representative (OCR) turns copy back to TR Area Manager (AM).

Other Contractor Representative TR Area Manager

Permit Receiver (Name/Signature/Card No) Permit Issuer (Name/Signature)

7. PERMIT EXTENSION
If work is not finished, Interface Work Permit can be extended only if there is no change in any of previous assessment.
Extension Date: _ Reason for Extension:

Other Contractor Representative TR Area Manager

Permit Receiver (Name/Signature/Card No) Permit Issuer (Name/Signature)
CRAFTSMEN MUST STOP THE WORK IF CONDITIONS CHANGE AND NEW HAZARD ARISES
This document is property of TR Integrated Gas and TR Saudia for Services and Contracting Co Ltd.
Its reproduction without previous permission in writing is strictly forbidden
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