Al-Dur II IWPP

Hole Protection / Grating Removal Permit

Department: Form No.:
Division/Subcontractor:
Application Date: Duration time:
Work Description
Equipment/System/Area Affected:
Required LOTO: Yes, No. of LOTO_________. No

Applied By
Subcontractor Subcontractor Sub. Scaffold
HSE Authority Engineer Supervisor
SEPCOIII Department/Division that Affected by This Work:
Department/Division manager： Signature：
HSE Department： Signature：

Grating may only be removed when the employees are equipped with fall protection, safeguarding / hard barricading for the hole
is provided, and warning signage is in place.

Hole Watch Yes / No Barricades Yes / No

Hole with cover anchored and secured □ Yes / □ No Safety Harnesses with twin lanyards and shock absorbers
□ Yes / □ No
Open hole cover must be of substantial material. Minimum - 25
mm undamaged wood.

Signage Provided - "DANGER– OPEN HOLE PROTECTION - Safe Anchorage □ Yes / □ No

DO NOT REMOVE"
□ Yes / □ No
ATTACH AREA PLOT PLAN INDICATING THE EXCACT LOCATION WHERE THE GRATING HAS TO BE REMOVED.

RESTORING OF WORK AREA

Grating put in place, clips attached If "no," is in the following condition:

□ Yes / □ No _________________________________________________________________

Hole filled in: □ Yes / □ No If "no," is in the following condition:

_________________________________________________________________

PTW CLOSE OUT

Date: Time: Receiver’s signature: Issuer’s signature: