Number MA-EHS-S-004.2 Revision #: 1.

0
Date Published:
Title Initial and Periodic Inspection Request Oct 25, 2017

MA-EHS-S-004-Industrial and Earth Moving Mobile Date Revised:

Equipment Feb 14, 2018

This is Ma’aden Aluminium Environment, Health and Safety Program. Before using this document, check the Ma‘aden Aluminium EHS Web site to ensure that it is the most
current version.

Section 1- Filled by requester

Date of inspection required: Click here to enter a date. Business Unit: Choose an item.

Requesting Time: Department:

Contractor Name

Contractor SPA

MA SPA

Type of Equipment

Equipment Model

Serial Number

Manufacturer

Operator Name

Operator License/Certificate Number (attach a copy)

Operator License/ Certificate Expiry Date

Section 2 - Filled by MA Inspector:
Confirmation:
Date: Time of Inspection:
Location of inspection: Inspector Mobile Number:
Inspector Land Number: Email :
Section 3 - Approval section after inspection filled by MA inspector
Equipment allowed to enter MA facility Yes No

Inspector Signature
Inspection Date and Time
 If requester is a contractor this form shall be send to MA SPA, who then sends to MA designated
inspector.
 After inspection this sheet shall be handover to Security Patrol to allow equipment release from
Inspection Area.
 If equipment is belonging to contactor an insurance copy, ownership document, third party inspection
report and contract document shall be attached.