= bmn COLD WORK PERMIT BIW Ref Ne: Project Name: | Contractor: _No. of Employees involved Expecied Completion Tr] Activity: Work Description: Tacation of jab to be performed Tool/Equipment 9 be used: | identify risk awariated with this Gold Work SCY Fall from Hei Adverse Weather [ Moving Vehicle? Equipment Falling Debris’ Objects Proiruding objecss, pats Faulty Tool! Material Noise Heat Pon Huei nation Ouher(Specily The following document must be attached with this permit | Method Stotement Risk Assessment ‘Othe: (speci - im Precaution require to complete the work safely Yes No [NA Tiave wols ond devices to be used been tested ond adjusted? Have all hazards/hazardous related to the this activities identified and assessed? Ci working ar height — CJ Scattolding 2 Presswe Test == C) Chemical Oy Elecuical CO SawiCoid cut =) Hot Sustace CTeo! & Equipments 2 Dus a i ‘Are permits associated require for this activity? If yes, mentioned below; ii work Chwarking at right 2 excavation EI Hecrricat 2) Confined Space ta bntey Ciker (speeily The following areas / items have been inspected by issuer and receiver AccessRgress | Mangere Wwarning Sign Lighting, | Safety Harriers Hand Tools ‘Other (specify) PPE Required tor the Helmet Salety Shoes Salewy Gloves Safety Car Plogyimull Salety poles Heflective Vest Dust_ Mask fry vlohes Tssue and acceptance before work Acceptance of Work Permission by the persan in-charge (Receiver) J certity chat, | have read and verified this work permit and checklist. { am aware of the risks that can be expased to. | commis chat I will be in tine: with all salixy rules menuumed in work porrmit cheuklist and will nut deflect any of them. Permit Receiver Name: SignatureDate: ‘Authority te proceed by authorized person (Issuer) Ireviewed dhe work permission ebechlis tel checked ua: working cua have reviowe ihe all npev of Une waka ‘sith the urangemer a tailed the "risk agsessinent” have bee atin place atl ceriy thatthe atviy detailed abewe Koceed Permit Issuer Name: Acknowledge by Conteactor's Safety Engineer Officer Name: Verification by SEC Consultant (Ii oppoimed for the project Name : Clearance and cancellation afier wark ar Suspension of permit Clearance, (Site Manager) {All men. materia. tools equipmen.. tousekeeping, efc under my charge have been withirnwe. The permitted work is complete /not complet [ Signature’ ‘This permit is suspended, 1 have notified the Auhorizad person specie tit the work isnot complete the area“ equipment not sate to wee ‘Name: | Signanire Date:Ce cere eee nee COLD WORK PERMIT wy) List of additional precaution measures required (SHC Consultant! Contractor's Safety Kngineer/ (fi Permit Re-Validation sh. Contractor's Safety Signature Verification by SHC Consultant This permit is valid for 7 days from the date of issue.CONFINED SPACE TO ENTRY PERMIT LList of additional precaution measures required (SEC Consultant/ Contractor's Safety Engineer! Officer) 1. 2. 2X 4 | Details of Entrants Entrant Name Details of Attendants ‘Attendant Name Entry Conditions ‘Confined Space Permit must be in place I you fit for work (health fitness) If you have adequate-appropriate PPE. ‘NameELECTRICAL (ISOLATION) PERMIT Date: ‘Number of Employees Starting From | Date | Energized Lines/Equipment De-Energized Line/ Equipment [_] Work Description: Location of job to be performed + “Tool/E quipments to be used = Identify risk associated with this Electrical work Electrocution Arc Flash Flying particles Noise Falling Objects Protruding objects, parts Tripping / Slipping Electric shock Fire Manual handling Electric Burn ‘Near Overhead lines Other(Specify): ‘The following document must be attached with this permit Method Statement Risk Assessment ‘Gree (specify): Precaution require to cormplete the work sal Yes [No | N/A Is the safe disiance maintained [ Yes a ee Does the work require access to confined spaces? If yes, obtain a Confined space entry permit Have all possible sources of electrical power been isolated, locked and properly tagged (LOTO)? Is below mentioned any ane of Isolation in place and the isolation followed as per procedure? EX 'Switch Out CItockouu/ Tag out No. af Locks as i been conliemed by testing thatthe Tines / equipment are desenergized ? Have tools and devices to be used been tested and adjusted? Other (specify): ‘The following areas / items have been inspected by issuer and receiver Fire Extinguisher Type. ‘Quant Access/Escape Route Danger/Waning Sif Lighting Stick Portable Radio Other (specify) (PPE Required for the Helmet Safety Shoes: Electrical Gloves ‘Half Mask Safety goggles Reflective Vest Dust Mask ‘Safety clothes Face shield ‘Arc flash PPE. Satety Ear Plugsimuff Other Issue and acceptance before work ‘Acceptance af Work Permission by the person in-charge (Receiver) Teertify that, 1 have cead and verified this work permit and checklist. I have been informed about the risk assessment results. fam aware of the tisks that can be exposed to, | comin that | will bein line with al safety nules mentioned in work periit checklist and will not deflect any of them. Permit Receiver Name: Signature/Date: ‘Authority to proceed by authorized person (Issuer) I reviewed the work permission checklist and checked the working conditions. | have reviewed the all aspects of the tash/activity and am satisfied with the arrangements as detailed in the “risk assessment” have heen put in place and cemity thatthe activity detailed above is authorized to proceed Permit fssuer Name: Signature/Date: ‘Acknovlege by Comtracir’s Solty EngioeentORier Signature/Date: aaa by SEC Consultant (If appointed for the project) Name : Signature/Date: (Clearance and cancellation after work or Suspension of permit Clearance. (Site Manager) |_All mea, materals, tools equipment. housekeeping ct. under my charge have beet withdrawn. The permitted work is complete / not complete. Name: Signature/Date: ‘Suspension “This permit is suspended, I have notified the Authorized person specified that the work is not complete the area / equipment is not safe to use. Name: Signature/Date:eal ELECTRICAL (ISOLATION) PERMIT Lisi of additional precaution measures required (SEC Consultant/ Contractor's Safety Engincer/ Officer) oA Permit Re-Validation Contractor's | Verification by St) pate | Time pets. Receive Safety SEC Remarks me ae Sona Signature | Consultant ‘This permit is valid for 7 days from the date of issue.EXCAVATION PERMIT Date: No. of Expected Completion Excavation / Trench Length: | Work Description: Location of jab to be performed “Tools/Equipment to be used: identify risk associated this Excavation Personnel Falling. Underground Ui Biological Falling Objects / Equipments Cave in (Callapse) Dust Flood Adjacent Structure Heat Other( Specify: Precaution to complete the work safe 15 method statement attached with this permit? is risk assessment attached with this permit? ‘Are the equipmentsmachineries inspected and valid certification available for equipment & operator ? 1s the hard barrier given and safe distance (at least 1 meter from the edge of excavation) maintained? ‘Are type of soll identified? if yes mention below © stable Rock) Type A OTypeB 0) Type C Will the excavation be 5 or more feet deep and will personnel be entering? If yes, state below the ‘control measures been implemented: Cishoring O shielding C)Benching Csioping Details: “Will the excavation be 20 or more feet deep? If yes, Name of Professional Engineer .. z Ze underground wiles checked below by means of appropriate detector trough as bald drawings, and marked aecardingly at the work location electrical O) sewer CCommunications Clstorm water Gas Line TTunderground utliies found, trial hale system (manual digging) is followed? ‘Are adequate inspection system followed for during, after excavation and backfilling? Other (pecify}: “The following areas / items have been inspected by issuer and receiver Danget/Wamning Si Lighting/Flickerin, Detector (multi) As built Drawing, Other (specify) Safety Shoes Mechanical Gloves Safety Ear Plogwimalt Reflective Vest Dust_ Mask Safety clothes Others (Specify): Issue and acceptance before work ‘Acceptance of Work Permission by the person in-charge (Receiver) 1 eemiy that, {have read and verified this work permit and checklist. [am aware of the risks that can be exposed to. | commit that I willbe in line ‘with all safety rales mentioned in work permit checktist and will nt deflect any of them, Permit Receiver Name: Signature/Date: ‘Authority to proceed by authorized person (Issuer) T reviewed the work permission checklist and checked the working Conditions. Thave reviewed the alf aspects of the tasWactivity and am saisied with the armngements as detailed in the “risk assessment” have been put in place and certs thatthe activity detaled abave &s authorize proceed Permit Issuer Name: Signature/Date: ‘Acknowledge by Contractor's Safety Engineer/OMicer Name : Signature/Date: Verification by SEC Consultant (if appointed for the project) Name : Signature/Date: ‘Clearance and cancellation after work or Suspension of permit Clearance, (Site Manager) All men, materials, tools equipment, housekeeping etc. under my charge have been withdrawn. The permitted work is complete / not complete. Name: Signature/Date: Suspension ‘This permit is suspended, | have notified the Authorized person specified that the work is not complete the area / equipment is nat saft 1 use. Name:Cy ene EXCAVATION PERMIT 9 List of additional precaution measures required (SEC Consultan Contractor's Safety Engineer’ Officer) 1 ee a 4 5 Permit Re-Validation : Contractor's | Verification by s Date Time leover. Receives: Safety SEC Remarks No signature | Sienatore | goat. | conmitant 1 2 3 4 5 6 7 ‘This permit is valid for 7 days from the date af issue.HOT WORK PERMIT Contractor: ‘Number of employees involved Starting From Expected Completion Date Time Bracing/Cutting/Grinding/Soldering C) ‘Work Description: Location of job to be performed: Tools/Equipment to be used: Tdentify risk associated with this Hot Wark Electrocution ‘Arc flash Flying particles Falling Objects Protmuding objects, parts Tripping / Slipping Manual handling Hot bum Fume /senoke Other(Specify): The following document must be attached with this permit Method Statemem | Risk Assessment ‘Other (specify): Precaution measures require to complete the work safely ‘Are you certified (welder) to undertake this work? Is Equipment/Machine inspected and color coding available of the current month? Are all combustible materials removed or shield from sparks? ‘Are the boses inspected? J Free from greasefoil LJ cuv/crack (Fitting (Special clips) ‘Are regulator and Gauges inspected ? CT Defects/Broken CJ Fiting CJCalibration © Oxygen - release not exceed SOpsi___[)_Acetylene - release not excess 15 psi ‘Are flash back arrestors provided? Are the cylinders provided with cap, trolley, chain and appropriate relieve valve? Are emergency ean evan place o contac mut dsplayed t ple? Contact Numbers: Have tools andl devices ile ec epee ad ena Other (specify): ‘The following areas / items have been inspected by issuer and receiver Fire Canopy ‘Danger/Waning Sign Lighting Safety Barriers Fire Watcher Fume Extractor/Ventitation |_| Friction light Container (Rods) Fire Blanket Sand Bucket Gther (specify) Salety Shoes ‘Welding Gloves Face shield ‘Apron (Welding) Gas Mask Ear Plags/muft ‘Welding shield Welding Clothes Others (specify): Issue and acceptance before work “Acceptance of Work Permission by the person in-charge I certify that, I have:read and verified this work permit and checklist. | am aware of the risks that can be exposed to, | commit that | will be in line with al safety rules mentioned in work permit checklist and will not deflect any of ther. Permit Receiver Name: Signature/Date: ‘Authority to proceed by authorized person (Issuer) Treviewed the work permission checklist and checked the working conditions. 1 have reviewed the all aspects ofthe tahiactvity and am ‘satisfied with the arrangements as detailed in the “risk assessment” have been put in place and certify that the activity detailed above is authorized to proceed. Permit Issuer Name: Signature/Date: ‘Acknowledge by Contractor's Safety Engincer/Officer Name : Signature/Date: ‘Verification by SEC Consultant (If appointed for the project) Name : Signature/Date: Clearance and cancellation after work or Suspension of permit ‘Clearance. (Site Allien, materials, tools equipment, housekeeping etc under my change have beos withdrawn, The permitted work is complete / not complete, Name: Signature/Date: ‘Suspension This permit ts suspended, I haye notified the Authorized person specified that the work is nat complete the area / equipment is not safe to use. Name: ‘| Signature/Date:oa Set HOT WORK PERMIT List of additional precaution measures required (SEC Cansultant/ Contractor's Safety Engineer/ Officer) Permit Re-Validation ‘sl e R Contractor's | Verification by No Date Time Signacare Safety SEC = Senin Signature Consultant ‘This permit is valid for 7 days from the date of issue.LIFTING OPERATION PERMIT Contractor Name: No. of Employees invalved “Time Expected Completion | Date Crawler Crane [ Overhead Crane Dimension (max) Tess than 10 ton (Rigger levels) |_| More than 10,0 400m (Rigger evel 2) | | Move shan a0 (cgier level) Serial No Vali lnspection Date [ capacity (SWE) [High Wind Moving Vehicle/ Equipment Tripping / Slipping Naise Collapse Near Overhead lines Traffic ‘Adverse Weather Othent Specify: The following document must be attached with this permit Method Statement Risk Assessment Lifting Plan (Refer procedure) Other (specify): Precaution require to complete the work safely g equipment certified by accredited center and complied with SEC list? Is the operator certified and hold valid license (KSA) to carried out this activity? Certified: Expiry Date ; License; Expiry Date: ‘Are all accessories inspected (rigging arrangements)? if yes state below Ci wire Rope sling CT Web Sling Clchatn sling C) Shackles Cl Eye Bott C1 other aie Goer ere ‘Crane capability at the given radius of operation? Is the rigger certified to carried out this activity as per the load limit? Name of Rigger: Rigger Level: ‘Validity: Expiry Date: Is ae acceptable to proceed the activity ? (stop stany a wind or more than 32km/h) The Toleiing sree items have been inspected ‘Ground condition Danger/Warning Sign Safety Barriers Tag line igger ‘Outrigger (extended) Lighting ‘Man/Material Basket (Certified) Mechanical Gloves Ear Plogsimuft Reflective Vest Dust_ Mask Safety clothes ‘Other (Specify Issue and acceptance before work ‘Acceptance of Work Permission by the person in-charge | certify tha, I have ead and verified this work permit and checklist | am aware ofthe risks that can be exposed to, | commit that Iwill be in tine ‘with all safety rules mentioned in work permit checklist and will nox deflect any af them. Permit Receiver Name: Signature/Date: ‘Authority to proceed by authorized person (Issuer) | reviewed the work permission checklist and checked the working conditions. have reviewed the all aspects of the task/actvity and ar satisfied ‘with the arrangements as denied im the “risk assessment” have been pu in place and setiy thatthe activity detailed! above fs authorizes 10 proceed! Permit Issuer Name: Signature/Date: ‘Acknowledge by Contractor's Safety Engincer/OMficer Name : ‘Verification by SEC Consultant (If appointed for the project) Name : ‘Clearance and cancellation after work or Suspension of permit ‘Clearance. (Site Manager) All men, materials, tools equipment, housekeeping etc under my change have been withdrawn. The permnitied work is complete / not complete, Name: Suspension ‘This permit is suspended. I have notified the Authorized person specified thatthe wark is not complete the area / equipment isnot safe to use. Name:Cc. es Aone at LIFTING OPERATION PERMIT ard List of additional precaution measures required (SEC Consultany Contractor's Safety Engineer! Officer) ‘This permit is valid for 7 days fram the date of issue.WORK AT HEIGHT PERMIT. Contractor: No. of Employees involved. Time | Expected Completion Date | Time Arial Lifts [~] | Roof Wark [_] | [_] Other; Specify: Location of job to be performed: ‘Tools/Equipment to be used: I risk associated with Work At Height Fall from Height Adverse Weather Flying particles Moving Vehicle! Equipment Falling Debris/ Objects Protruding objects, parts |__| Tripping / Slipping ulty Equipment/ Material Fragile surface (Roof [Work Under Below ‘Near Overhead lines ‘Near energized equipment ‘Orher( Specify}: “The following document must be attached with this permit Method Statement | Risk Assessment Ciher (specify: ‘Precaution require to complete the work safely [ves No | NIA Have the risk control’s been implemented? if yes state below Fall Protection: (_] Guard Rails system [_] Safety Net [Toe Board Fall restraint : [7] Life Line [_] Retractable Hamess Fall arrest. = [7] Harness with Shock absorber & Double Hook ‘Have proper access/egress been provided? T 1s wind speed greater than 32 kiwh? If yes, do not proceed the activity tT ‘Are all floor openings at roof adequately covered/protected to prevent falling? Is the scaffold erected and inspected by Certified person? (if no do nat proceed the activity) Are the scaffold , ladder, Arial lift inspected it? Name of Date of In tion: ‘Other (specify): ‘The following areas / items have been inspected by issuer and receiver Dangev/Waming Sign Scaffold Tag System Lighting Safety Barriers Buddy System, Rescue Material basket Other (specify: PPE Ri far the acti Helmet with Chin strap Safety Shoes Safety Gloves Safety Ear Plogainmutt Safety goggles Reflective Vest Dust Mask Safety clothes ‘Other (Specify): ‘Tssue and acceptance before work ‘Acceptance of Work Permission by the person in-charge (Receiver) certify that, | have read and verified this work permit and checklist. 1 have been informed about the risk assessment results, | am aware of the risks Mata be exposed 1.1 cei that | wil be fa ine with all safety eules menoned in work permit checklist and will not deflect any of Signature/Date: reviewed the work permission eheehlist and checked the working conditions, | have reviewed the all aspects of the task/activity and am satisfied ‘with the arrangements as detailed in the “risk assessment” have been putin place and certify that the activity detailed abave is authorized 1 Permit Issuer Name: Signature/Date: Signature/Date: ‘Verification by SEC Consultant (If appointed for the project) Name: Signature/Date: ‘Clearance and cancellation after work or Suspension of permit ‘Clearance. (Site Manager) All men, materials, ools equipment, housekeeping cic. under my charge have been withdrawn. The pemisted work is complete / not complete. Name: Signature/Date: SI ‘This permit is suspended, | have notified the Authorized person specified that the work is not complete the area / equipment fs not safe to use. Name: Signature/Date:+ sea pts WORK AT HEIGHT PERMIT List of additional precaution measures required (SEC Consultany/ Contractor's Safety Engineer’ Officer) 1 2 a Bk | pate | Time | Issuer Signature Receiver Signature Contractor's Safety Signature Verification by SEC Consultant Remarks ‘This permit is valid for 7 days from the date of issue.