Al Sahel Contracting Company LLC Doc. Ref.

FM-10031
Revision 03
RISK / IMPACT ASSESSMENT Date Jan-2018

LOCATION / PROJECT JOB NO. ASSESSMENT NO.

POTENTIAL HAZARDS / CONDITIONS TO BE CONSIDERED

Deep Excavations Storage / Lay Down Area Fall from Height Fire Risk Noise Young Persons
Demolition Confined Spaces Slips / Tripping Noise / Dust / Vibration VDU Expectant Mothers
Plant / Machinery Working Platforms/Ladders Fuel Storage Fumes Ergonomics S/C Workers
Lifting Operations Manual Handling Storage / Lay Down Area Traffic High Winds General Public / Visitors
Buried / Overhead Services COSHH Ground Conditions Smoke Adverse Weather Others

TASK:
Evaluation of Residual
Potential Hazards / Normal / Abnormal / Hazard Effect Who or What Might be Risk/Impact Control Measures or Risk/Impact Level Control /
No. Activity OHS or E Status
Aspect Emergency / Harm Harmed Recovery Measures Influence
S L R/I S L R/I

1 5 1 5 5 1 5

2 5 2 10 5 2 10

3 5 3 15 5 3 15

4 - -

5 - -

FOLLOWING STEPS TO BE FOLLOWED WHILE EVALUATING THE HAZARDS AND RISK FOR EACH ACTIVITY.
SEVERITY OF CONSEQUENCES LIKELIHOOD / PROBABILITY HIERARCHY OF CONTROLS MATRIX
DESCRIPTION SCALE LIKELIHOOD / PROBABILITY SCALE SL. # DESCRIPTION If the severity/Impect rating lies between 5 to 25, then
ELIMINATION
corrective actions needs to be taken by concerned
FATALITY / CATASTROPHIC 5 ALMOST CERTAIN 5 1
persons with documentary evidence
4 LIKELY 4 2 SUBSTITUTION LIKELIHOOD / PROBABILITY (L)

.
MAJOR HEALTH IMPACT / INJURY, DAMAGE TO COMMUNITY*

SQ
N
ENGINEERING CONTROL 1 2 3 4 5

O
MINOR INJURY / MODERATE 3 POSSIBLE 3 3

C
FIRST AID / MINOR 2 UNLIKELY 2 4 SIGNAGE/WARNING/ADMIN. CONTROLS 1 1 2 3 4 5

SEVERITY
NEGLIGIBLE / INSIGNIFICANT 1 RARE 1 5 PPE'S 2 2 4 6 8 10
* Major health impact, damage to community, major asset loss, or major injury (damaging, disabling illness). 3

(S)
3 6 9 12 15
COLOUR CODE RISK or IMPACT LEVEL / RATING MEASURES TO BE TAKEN 4 4 8 12 16 20
RED EXTREME 15-25 & special cases WORK CANNOT PROCEED, ENGINEERING MEASURES REQUIRED 5 5 10 15 20 25
ORANGE HIGH 10-12 IMMEDIATE CORRECTION MEASURES REQUIRED R = S X L WHERE: R / I = RISK / IMPECT RATING
YELLOW MEDIUM 4-9 REVIEW REQUIRED FOR ADDITIONAL MEASURES S = SEVERITY
GREEN LOW 1-4 NO ACTION REQUIRED OR ACCEPTABLE RISK/IMPACT L = LIKELIHOOD / PROBABILITY
Final Assessment: Provided that there are no deviations from control measures, the residual risk assumed is low. Supplementary measures should include using the correct PPE and safety Tool Box Talk to
ensure that all workers are fully aware of the control measures.
Updated on:
Revision No.:
Assessed By: Verified By (PROJECT MANAGER) Approved By (CLIENT / CONSULTANT)
Name: Name: Name:

Signature: Signature: Signature:

Date/Time: Date/Time: Date/Time:
 Al Sahel Contracting Company LLC Doc. Ref. FM-10031
Revision 03
RISK / IMPACT ASSESSMENT Date Jan-2018

LOCATION / PROJECT JOB NO. ASSESSMENT NO.

POTENTIAL HAZARDS / CONDITIONS TO BE CONSIDERED

Deep Excavations Storage / Lay Down Area Fall from Height Fire Risk Noise Young Persons
Demolition Confined Spaces Slips / Tripping Noise / Dust / Vibration VDU Expectant Mothers
Plant / Machinery Working Platforms/Ladders Fuel Storage Fumes Ergonomics S/C Workers
Lifting Operations Manual Handling Storage / Lay Down Area Traffic High Winds General Public / Visitors
Buried / Overhead Services COSHH Ground Conditions Smoke Adverse Weather Others

TASK:
Evaluation of Residual
Potential Hazards / Normal / Abnormal / Hazard Effect Who or What Might be Risk/Impact Control Measures or Risk/Impact Level Control /
No. Activity OHS or E Status
Aspect Emergency / Harm Harmed Recovery Measures Influence
S L R/I S L R/I

1 5 1 5 5 1 5

2 5 2 10 5 2 10

3 5 3 15 5 3 15

4 4 3 12 -

5 - -

FOLLOWING STEPS TO BE FOLLOWED WHILE EVALUATING THE HAZARDS AND RISK FOR EACH ACTIVITY.
SEVERITY OF CONSEQUENCES LIKELIHOOD / PROBABILITY HIERARCHY OF CONTROLS MATRIX
DESCRIPTION SCALE LIKELIHOOD / PROBABILITY SCALE SL. # DESCRIPTION If the severity/Impect rating lies between 5 to 25, then
ELIMINATION
corrective actions needs to be taken by concerned
FATALITY / CATASTROPHIC 5 ALMOST CERTAIN 5 1
persons with documentary evidence
4 LIKELY 4 2 SUBSTITUTION LIKELIHOOD / PROBABILITY (L)

.
MAJOR HEALTH IMPACT / INJURY, DAMAGE TO COMMUNITY*

SQ
N
ENGINEERING CONTROL 1 2 3 4 5

O
MINOR INJURY / MODERATE 3 POSSIBLE 3 3

C
FIRST AID / MINOR 2 UNLIKELY 2 4 SIGNAGE/WARNING/ADMIN. CONTROLS 1 1 2 3 4 5

SEVERITY
NEGLIGIBLE / INSIGNIFICANT 1 RARE 1 5 PPE'S 2 2 4 6 8 10
* Major health impact, damage to community, major asset loss, or major injury (damaging, disabling illness). 3

(S)
3 6 9 12 15
COLOUR CODE RISK or IMPACT LEVEL / RATING MEASURES TO BE TAKEN 4 4 8 12 16 20
RED EXTREME 15-25 & special cases WORK CANNOT PROCEED, ENGINEERING MEASURES REQUIRED 5 5 10 15 20 25
ORANGE HIGH 10-12 IMMEDIATE CORRECTION MEASURES REQUIRED R = S X L WHERE: R / I = RISK / IMPECT RATING
YELLOW MEDIUM 4-9 REVIEW REQUIRED FOR ADDITIONAL MEASURES S = SEVERITY
GREEN LOW 1-4 NO ACTION REQUIRED OR ACCEPTABLE RISK/IMPACT L = LIKELIHOOD / PROBABILITY
Final Assessment: Provided that there are no deviations from control measures, the residual risk assumed is low. Supplementary measures should include using the correct PPE and safety Tool Box Talk to
ensure that all workers are fully aware of the control measures.
Updated on:
Revision No.:
Assessed By: Verified By (PROJECT MANAGER) Approved By (CLIENT / CONSULTANT)
Name: Name: Name:

Signature: Signature: Signature:

Date/Time: Date/Time: Date/Time:
 RISK ASSESSMENT-INSTALLATION AND T&C OF FM200 SYSTEM

VIDA 1-4 AT BLOCKK(B+G+9F+R) HOTEL, SERVICED&BRANDED APARTMENTS, PLOT NO:763,

LOCATION / PROJECT
MUWAILAH, SHARJAH, UAE
JOB NO. J-374 ASSESSMENT NO.

POTENTIAL HAZARDS / CONDITIONS TO BE CONSIDERED

Deep Excavations Storage / Lay Down Area Fall from Height Fire Risk Noise Young Persons
Demolition Confined Spaces Slips / Tripping Noise / Dust / Vibration VDU Expectant Mothers
Plant / Machinery Working Platforms/Ladders Fuel Storage Fumes Ergonomics S/C Workers
Lifting Operations Manual Handling Storage / Lay Down Area Traffic High Winds General Public / Visitors
Buried / Overhead Services COSHH Ground Conditions Smoke Adverse Weather Others

TASK: INSTALLATION OF FM 200 SYSTEM

Evaluation of Residual
Legal Requirements Normal /
Hazard Effect / Who or What Risk/Impact Risk/Impact Level
No. Activity Potential Hazards / Aspect OHS or E Abnormal / Control Measures or Recovery Measures Status Control / Influence
Harm Might be Harmed
Emergency
Yes / No If Yes, Provide the Ref. S L R/I S L R/I

1 Transportation & Delivery YES DMCOP *Collisions involving delivery
of Materials at site chapter 20 vehicles, other site vehicles, or
(offloading) pedestrians
*Injuries related to manual lifting,
carrying, and unloading of
materials.
*Objects falling from delivery
vehicles during unloading
*Risks associated with the use of
forklifts, cranes, or other
machinery during unloading.
*Exposure to hazardous materials
during transportation and
unloading
OHS NORMAL Serious injuries Drivers, 4 3 12 *Designatedpathways, implement speed 1 4 4 ALARP CONTROL
pedestrians, limits, provide training for drivers.
other road
users,Workers *Provide mechanical aids (cranes, forklifts),
involved,Work training on proper lifting techniques,and
ers in the minimize manual handling where possible.
vicinity, *Use barricades and
warning signs, enforce restricted access
zones, secure materials properly during
transport inside the site. *Proper
labeling and documentation, employee
training on handling hazardous materials,
emergency response plans. *Ensure proper
supervision for the task. *Makesure the
equipment is certified and operator is
competent for the operation. * Use
proper personal protective equipment (PPE)

2 Pre-installation procedure
of FM200 system
No *Risks associated with working OHS NORMAL Serious Workers 4 3 12 *Ensure that power sources are properly shut 1 4 4 ALARP CONTROL
with electrical systems during the injuries/Minor involved in off before installation
installation process. injuries task ,tresspass *Use
*The system operates under ers and appropriate PPE for confined space work.
pressure, and there is a risk of Foreman
pressure-related incidents during *Use appropriate tools and
installation. equipment to conduct pressure tests
*Exposure to the clean agent according to manufacturer specifications.
(FM200) during installation. *Ensure that
*Risks associated with the workers have and use appropriate PPE,
handling and movement of heavy including gloves, masks, goggles, and other
equipment and cylinders. necessary protective gear.
*Poor ventilation during
installation can lead to the
accumulation of gases or fumes.
*The installation
process may involve hot work or
activities that could pose a fire
risk.

< FORM NO.: FM-10031 | REV.: 04 | DATE: Apr-2022 >

 TASK: INSTALLATION OF FM 200 SYSTEM
Evaluation of Residual
Legal Requirements Normal /
Hazard Effect / Who or What Risk/Impact Risk/Impact Level
No. Activity Potential Hazards / Aspect OHS or E Abnormal / Control Measures or Recovery Measures Status Control / Influence
Harm Might be Harmed
Emergency
Yes / No If Yes, Provide the Ref. S L R/I S L R/I

3 Shifting of Pipes through
manual handling
4 Painting of pipes
in the designated painting
areas/Workshop
YES DM *Improper handling
COP,CHAPT *Unclear route
ER 7 * Obstructed access
* Lack of training
* Heavy load
* Unsecured grip
* Unfit personnel
* Using inappropriate PPE
YES DM
COP,CHAPT * Exposure to paint and solvents
ER 18 can lead to skin irritation,
respiratory issues, and other
health problems.
* Inhaling paint fumes can cause
respiratory irritation, dizziness,
and headaches.
*Combustible paints and solvents
pose a fire hazard, especially in
the presence of ignition sources.
* Wet or spilled paint on the floor
can create slip and fall hazards.
* Lifting and maneuvering pipes
can lead to musculoskeletal
injuries.
The use of power tools and
equipment can result in high noise
levels, leading to hearing damage.
*Dust from surface preparation
and paint application can be
harmful to the respiratory system.
OHS NORMAL Back Injury/ Workers 3 3 9 *Ensure workers involve in manual handling 1 3 3 ALARP CONTROL
Muscle strains/ involved in shall receive a training of proper handling
Slip and trip/ task ,tresspass technique.
Pinch-points ers and * Unfit personnel are not allowed to
Fatigue/ Foreman manually handle the pipes.
Crushed body *Avoid manual handling if possible.
parts *Use mechanical handling aid
equipment such as pallet trolley whenever
possible.
* Clear access routes .
*Use suitable non-slip hand gloves.
*Regular rest breaks on high temperature and
humidity atmospheric condition.
E NORMAL Irritation, 4 3 12 *Use respiratory protection, ensure adequate 1 3 3 ALARP CONTROL
dizziness, and Painters, ventilation
headaches./slip supervisors, *Keep the painting area well-
and fall and other ventilated, avoid open flames, and have
hazards/ workers in the firefighting equipment, such as fire
musculoskeletal vicinity. extinguishers, readily available *Keep
injuries/ the work area clean, use non-slip floor
coatings, and provide proper signage. Ensure
workers wear appropriate footwear.
*Provide lifting aids, train workers in
proper lifting techniques, and implement
ergonomic practices. Use mechanical lifting
devices when feasible. *Implement
dust control measures, and provide training
on the proper use of protective equipment.
*
*Store paints and solvents in designated
areas, following manufacturer guidelines.
Train workers on safe handling practices
(chemical store). *Provide comprehensive
training for workers on hazard recognition,
proper use of equipment, and emergency
response procedures.
*Conduct regular inspections of safety
measures to identify and address potential
issues promptly.

< FORM NO.: FM-10031 | REV.: 04 | DATE: Apr-2022 >

 TASK: INSTALLATION OF FM 200 SYSTEM
Evaluation of Residual
Legal Requirements Normal /
Hazard Effect / Who or What Risk/Impact Risk/Impact Level
No. Activity Potential Hazards / Aspect OHS or E Abnormal / Control Measures or Recovery Measures Status Control / Influence
Harm Might be Harmed
Emergency
Yes / No If Yes, Provide the Ref. S L R/I S L R/I

5 Threading of GI pipes
using threading machine
YES DM *Risks associated with the OHS NORMAL Slips, Workers 3 3 9 *Provide comprehensive training for workers 1 3 3 ALARP CONTROL
COP,CHAPT moving parts of the threading trips,Cuts, Performing the on the safe operation of threading machines,
ER 18 machine, such as rotating dies and abrasions, or Threading,Sup including hazard recognition, emergency
gears posses chances for crush ervisors and procedures, and the proper use of personal
entanglement *Lifting, injuries,muscul Managers,Adj protective equipment.
positioning, and maneuvering of oskeletal acent Workers *Conduct regular inspections of the
heavy pipes can lead to injuries, threading machine, tools, and safety
musculoskeletal injuries. including equipment to identify and address potential
*Electrical components of the strains and issues promptly ensure the machine is tagged
threading machine pose a risk of sprains,mild using the monthly colour code.
electric shock shocks,burns to *Develop and communicate an
*Exposure to cutting fluids or the skin,kin emergency response plan that includes
lubricants may cause skin irritation, procedures for machine malfunctions,
irritation or respiratory issues. dermatitis electrical issues, and other potential
emergencies. *Ensure that
threading dies and cutting tools are in good
condition and properly secured. Train
workers on the safe handling and storage of
tools *Maintain a
clean and organized workspace to minimize
tripping hazards and facilitate safe movement
around the threading machine

6 Grooving of pipes using YES DMCOP,CH *Risks associated with the OHS NORMAL Slips, Workers 3 3 9 *Provide comprehensive training for workers 1 3 3 ALARP CONTROL
Pipe Grooving APTER 18 moving parts of the threading trips,Cuts, Performing the on the safe operation of grooving machines,
Machine machine, such as rotating dies and abrasions, or grooving,Supe including hazard recognition, emergency
gears posses chances for crush rvisors and procedures, and the proper use of personal
entanglement *Lifting, injuries,muscul Managers,Adj protective equipment.
positioning, and maneuvering of oskeletal acent Workers *Conduct regular inspections of the grooving
heavy pipes can lead to injuries, machine, tools, and safety equipment to
musculoskeletal injuries. including identify and address potential issues
*Electrical components of the strains and promptly,ensure the machine is tagged using
threading machine pose a risk of sprains,mild the monthly colour code. *Develop and
electric shock shocks,burns to communicate an emergency response plan
*Exposure to cutting fluids or the skin,kin that includes procedures for machine
lubricants may cause skin irritation, malfunctions, electrical issues, and other
irritation or respiratory issues. dermatitis potential emergencies. *Train
workers on the safe handling and storage of
tools *Maintain a
clean and organized workspace to minimize
tripping hazards and facilitate safe movement
around the threading machine

< FORM NO.: FM-10031 | REV.: 04 | DATE: Apr-2022 >

 TASK: INSTALLATION OF FM 200 SYSTEM
Evaluation of Residual
Legal Requirements Normal /
Hazard Effect / Who or What Risk/Impact Risk/Impact Level
No. Activity Potential Hazards / Aspect OHS or E Abnormal / Control Measures or Recovery Measures Status Control / Influence
Harm Might be Harmed
Emergency
Yes / No If Yes, Provide the Ref. S L R/I S L R/I

7 Cutting of pipes to its YES DMCOP,CH *Risks associated with moving
desired length by the use of
pipe cutting machine
OHS NORMAL Cuts, abrasions, Workers 3 3 9 *Provide machine guards to prevent contact 1 3 3 ALARP CONTROL
APTER 14 parts of the pipe cutting machine, or crushing Performing the with moving parts.
including blades. injuries Cutting,Worke *Ensure proper maintenance and inspection
*Lifting, positioning, and rs Handling of the cutting machine is done and tagged
maneuvering pipes can lead to Materials,Elec with the monthly color code.
musculoskeletal injuries. tricians,Adjace *Train workers on safe machine operation.
*Operation of the cutting machine nt *Provide workers with appropriate PPE,
can generate high noise levels. Workers,Super including gloves and eye protection.
*Cutting metal pipes can produce visors and *Implement regular cleaning procedures to
sharp metallic shavings Managers remove metal shavings from the work area.
*Electrical components of the
cutting machine pose a risk of
electric shock.

8 Mounting of FM200 No *Manual Handling and OHS NORMAL Cuts, Workers 3 3 9 *Provide comprehensive training on safe 1 3 3 ALARP CONTROL
cylinder Ergonomic Hazards abrasions, or Mounting mounting procedures, the use of equipment,
*Falling Hazards impact Cylinders,Sup and hazard recognition.
*Pinch Points and injuries,Muscul ervisors and *Provide appropriate PPE, including gloves,
Crush Hazards *Manual Handling oskeletal Managers,Wor safety glasses, fall protection equipment, and
of Tools *Chemical Exposure injuries, falls, kers Handling respiratory protection if needed.
*Fire Hazards pinch points, Tools,Adjacen *Use mechanical lifting aids or equipment to
crush injuries, t Workers minimize manual handling risks.
chemical *Implement fall protection measures like
exposure safety harness
*Implement machine guarding to prevent
pinch points and crush injuries.
*Ensure that tools and equipment used for
mounting are in good condition and suitable
for the task.
*Follow proper procedures for handling
lubricants, cleaning agents, or any chemicals
used in the mounting process.
*Eliminate or control ignition sources and
have firefighting equipment readily
available.
*Promote effective communication among
workers, supervisors, and other stakeholders
regarding safety procedures and potential
hazards

< FORM NO.: FM-10031 | REV.: 04 | DATE: Apr-2022 >

 TASK: INSTALLATION OF FM 200 SYSTEM
Evaluation of Residual
Legal Requirements Normal /
Hazard Effect / Who or What Risk/Impact Risk/Impact Level
No. Activity Potential Hazards / Aspect OHS or E Abnormal / Control Measures or Recovery Measures Status Control / Influence
Harm Might be Harmed
Emergency
Yes / No If Yes, Provide the Ref. S L R/I S L R/I

9 Working at height using YES DMCOP,CH *The risk of person falling from OHS NORMAL Minor sprains Workers on 4 3 12 *Install guardrails, toe boards, & use 1 3 3 ALARP CONTROL
aluminium mobile APTER 8 heights while working on the and fractures to the personal fall arrest systems to prevent falls.
scaffolding in installing scaffolding or fatalities Scaffolding,W *Regularly inspect the scaffolding for
pipes and fittings for water *The scaffolding may collapse orkers Below ensuring its complete inspected and tagged.
spray system. due to instability or improper the *Secure tools and prevent falling objects
assembly *Tools, equipment, or Scaffolding,Ot *Adhere to weight limits and avoid
materials may fall from the her workers in overloading the scaffolding
scaffolding *Inadequate access the *Provide training for the team involved in
and egress points to the vicinity,Forem the activity regarding scaffolding asfety and
scaffolding ans and safe wok at height teachnique,
supervisors

10 Removal of scrap pipes and YES DMCOP,CH *Trip and Slip Hazard
clearing the workplace.
(Housekeeping)
OHS/E NORMAL Strains, sprains, Workers 3 2 6 *Implement regular housekeeping 3 1 3 ALARP CONTROL
APTER 8 *Sharp Edges and Protrusions and other Removing procedures to keep the workplace clean and
*Improperly stacked or stored musculoskeletal Scrap organized *Train workers on proper stacking
scrap pipes may fall causing injuries,Injuries Pipes,Other and storage procedures for scrap pipes
injuries caused by sharp Workers in the *Conduct regular inspections of the work
*stains from excess oils and objects, Area area to identify and address potential
shellac protruding hazards. *Ensure surfaces are slip-resistant,
*Insufficient personal protective materials,Skin and promptly clean up spills or debris
equipment (PPE) may increase the irritation,
risk of injuries respiratory
issues,slip &trip

FOLLOWING STEPS TO BE FOLLOWED WHILE EVALUATING THE HAZARDS AND RISK FOR EACH ACTIVITY.
SEVERITY OF CONSEQUENCES LIKELIHOOD / PROBABILITY HIERARCHY OF CONTROLS MATRIX
LIKELIHOOD /
DESCRIPTION SCALE SCALE SL. # DESCRIPTION
PROBABILITY If the severity/Impact rating lies between 5 to 25, then corrective actions
FATALITY / CATASTROPHIC 5 ALMOST CERTAIN 5 1
needs to be taken by concerned persons with documentary evidence
ELIMINATION
MAJOR HEALTH IMPACT / INJURY, DAMAGE TO COMMUNITY* 4 LIKELY 4 2 SUBSTITUTION LIKELIHOOD / PROBABILITY (L)

.
SQ
MINOR INJURY / MODERATE

N
3 POSSIBLE 3 3 ENGINEERING CONTROL 1 2 3 4 5

O
C
FIRST AID / MINOR 2 UNLIKELY 2 4 1 1 2 3 4 5
SIGNAGE/WARNING/ADMIN. CONTROLS

SEVERITY (S)
NEGLIGIBLE / INSIGNIFICANT 1 RARE 1 5 2 4 6 8 10
PPE'S 2

* Major health impact, damage to community, major asset loss, or major injury (damaging, disabling illness). 3 3 6 9 12 15
COLOUR CODE RISK or IMPACT LEVEL / RATING MEASURES TO BE TAKEN 4 4 8 12 16 20
RED EXTREME 15-25 & special cases WORK CANNOT PROCEED, ENGINEERING MEASURES REQUIRED 5 5 10 15 20 25
ORANGE HIGH 10-12 IMMEDIATE CORRECTION MEASURES REQUIRED R=SXL WHERE: R / I = RISK / IMPACT RATING

YELLOW MEDIUM 5-9 REVIEW REQUIRED FOR ADDITIONAL MEASURES S = SEVERITY

< FORM NO.: FM-10031 | REV.: 04 | DATE: Apr-2022 >

 TASK: INSTALLATION OF FM 200 SYSTEM
Evaluation of Residual
Legal Requirements Normal /
Hazard Effect / Who or What Risk/Impact Risk/Impact Level
No. Activity Potential Hazards / Aspect OHS or E Abnormal / Control Measures or Recovery Measures Status Control / Influence
Harm Might be Harmed
Emergency
Yes / No If Yes, Provide the Ref. S L R/I S L R/I

GREEN LOW 1-4 NO ACTION REQUIRED OR ACCEPTABLE RISK/IMPACT L = LIKELIHOOD / PROBABILITY

Final Assessment: Provided that there are no deviations from control measures, the residual risk assumed is low. Supplementary measures should include using the correct PPE and safety Tool Box Talk to ensure that all workers are fully
aware of the control measures.

Updated on: 11/20/2023 Revision no. 0

Assessed By: Verified By: Approved By:

Name: Arunkumar Subash Name: Nimer Fares Name:
Signature: Signature: Signature:
Date/Time: 11/20/2023 Date/Time: 11/20/2023 Date/Time:

< FORM NO.: FM-10031 | REV.: 04 | DATE: Apr-2022 >