U Ims Ohs 45004a Work Permits

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HSSE DEPARTMENT

Permit to Work Procedure


PERMIT TO WORK Ref. No. U-IMS-OHS-45004A
Revision: 0 Date 01-01-2020

Section 1: Applicant's Details & Declaration (To be filled by the applicant)


Submission Date Supervisor in Charge

Contractor's Name Office Number


Requester's Name P O Box
Mobile Number Email Address
Number of Workers

I hereby certify that all the information I have provided is correct and agree to
comply with all requirements and Health & Safety standards of UDC and the
State of Qatar with full knowledge that this permit may be revoked at any time
with a possible fine applied should we be found in violation of its conditions.
Company Stamp

Signature

Section 2: Location & Description of Work (To be filled by the applicant)

Specify Exact
Location/Address:

Description of work
to be conducted:

Period of Work Dates: Working Hours:


From:_______________ To:________________

Section 3: Conditions of Permit


1. To submit the following documents:
p Original WP Form - typewritten, duly signed by applicant & sealed with their company stamp.
p HSSE standard requirements - Method Statement & Risk Assessment (signed & stamped by the person in authority from the applicant's company); HSE procedures to be
implemented including safety signages; if mobile crane operation is applicable, applicant must provide credentials of operator.
p. Others - related documents i.e. scope of work including plans & specifications related to work, email/letter approved by UDC, UDC LPO copy, etc._xDD00_

2. Standard working hours are SAT to THURS, 07:30 till 17:30 however. Noisy Works is strictly restricted to SUN to THURS, 08:00 till 17:00. No work is authorized on
Fridays or during public holidays.
3. The Contractor shall abide by all regulations and Health & Safety standards of UDC and the laws of the State of Qatar:
p Provision of Fire Extinguishers (ref. QCD FSS / UDC CR HSE Manual Section 39 / QCS 2014 Section 01 Part 10)
p Provision of First Aid Medicine Kits and First Aider (ref. Qatar Labor Law Part 10 Article 104 / UDC CR HSE Manual Section 26 / QCS 2014 Section 01 Part 10)
p Arrangement of Safety Officer (ref. UDC CR Sub-Clause 2.3.2 / QCS 2014 Section 01 Part 10 Clause 10.1.3)

4. Area of work to be covered/hoarded and protected if deemed necessary by UDC. Upon work completion, the area of work must be reinstated to it's original state
including maintainance and repair. As per UDC regulations, a fine/Penalty shall be enforced otherwise.

5. Applicant shall ensure work area is clean and presentable at all times. As per UDC regulations, a Fine/Penalty shall be enforced otherwise.
6. No road closure is allowed under this permit.
7. All safety signage stated below must be displayed onsite BEFORE work can begin. It must always be laminated, visible and in good condition.
8. Should the applicant require to work outside the days/times specified above, a justification letter is required. Without it, the application is rejected.
9. Applicant shall ensure trucks entering/leaving the site shall not soil the road. As per UDC regulations, a fine/Penalty shall be enforced otherwise.
10. All works carried out on The Pearl must display the “Project Information Board’ by sponsoring Dept. ‘PIB’.
Section 4: UDC Approval (For UDC Internal Use Only)

Community Services
Comments
Responsible
HSSE Comments
Department Comments

Reviewed by | Position

Signature | Date

Reviewed by | Position Reviewed by | Position Approved by | Position

Signature | Date Signature | Date Signature | Date

Approval Approval Approval


Stamp Stamp Stamp

Work in Supervisor Deep


Fire Exit PPE
Progress Details Falling Excavation
Road
Safety Signage Wet Paint No Entry Elevator
Debris Closure
PIBD

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