| HOT WORK PERMIT ISSU

Permit No: 130000429020 Previous Permit No: Maintenance Plant: 1219-Gas Bab
Work Order No:
SECTION 1: PERMIT REQUEST
1. (a) Nature of Work / High Risk Activity

Scaffolding Work Lifting Manual Handling Driving

1. (b) Work Title Created by CT90007215 Created on 21/05/2024 03:06 PM

Mob/Demob, scaffolding,preparation Planned start date 22/05/2024 07:00 AM
Planned Finish date 28/05/2024 06:59 PM
1. (c) Location / Equipment * Authorization Group Operations
Location / Area Equipment ID. Description Process / Non - Process /
Area ✔
Restricted Unrestricted
OGD I TH "F" TL-1 GI From Area15- H2S Zone R A ✔ Y G NC
A-ON-1130-TKIG-01
Bb360GI
HAC Zone 0 1 2 ✔ NC
OGDI TH "F" TL-2 GI From Area15-
A-ON-1130-TKIG-02 Dust Zone 20 21 22 NC ✔
Bb365GI
1. (d) Description of Work
* Mobilization /Demobilization of IPS Tools & accessories, Diesel* batching equipment, diesel tank, Nitrogen Package, diesel transfer &* hose rig up/ down
activities, deployment of AGM Markers, GPS* Anchoring, scaffolding modification, Preparatory work for pigging* activity
1. (e) Work Equipment Details Job Performer (JP) Details:
Air compressor, diesel pump, IPS tools, tanks, vent silencer, Discipline / Department Inspection Foreman, GBB
Tools to be used pushing./ pulling rods, drip trays, crane , hiab, pick up, AG Job Performer (JP1) Mohamed Shafeeq
markers, GPS unit, Drums & hand tools, nitrogen unit, frac tank
Job Performer (JP2) ()
Hiab, trailer, crane, compressor, diesel pump, diesel generator,
Sources of Ignition Planned No. of workers 10 Contractor Yes ✔ No
pick-up
Break In /
Work Planning (IWAP) Planned ✔
Hazardous Materials Involved H2S, Hydrocarbon, Emergency

Contractor Company TRANS ASIA PIPELINE & SPECIALTY SERVICES L.L.C

1. (f) Work Permit Request by Performing Authority (PA)
I confirm that the details in the permit and associated attachments provide a clear description of the work to be performed including tools, materials and any
specialist skills required. I declare that the JP identified for the work activity is competent to conduct the specified work activity
Name (Performing Authority) Company Employee ID Position Date&Time Sign Revert
Saud AlYarrah AD00152016 Engineer, Inspection 21/05/2024 11:56 PM Signed
SECTION 2 - WORKSITE CONTROLS AND SUPPORTING DOCUMENTS
Certificates: ( if reqd.) No # Attachments: (if reqd.) Title Other Details
1. Isolation 1. Method Statement ROSEN IPS Metho JSA (Ref. No.) 330000322252
2. Temp. Defeat 2. Lifting Plan Permit Endorsement Require Yes No ✔

3. Atmospheric Test 280000925282 3. P&ID Planned SIMOPS Yes No ✔

4. Confined Space Entry 4. Rescue Plan Site Visit Role Frequency

5. Radiography 5. Journey Management Plan Area Authority NA
6. Vehicle Entry 250000292505 6. Hazard & Control Sheet Asset Approving Authority NA
7. Excavation 7. Job Safety Analysis ✔ 330000322252 HSE NA
8. Diving 8. Associated Permits Performing Authority Once
9. Road Closure Other: PTW Coordinator NA
10. Easement LFI

11. Lesson Learnt

Special Precautions
Additional Certificates
Additional Attachments
Permit Dependency
2. (b) Work Permit Validation by Area Authority (AA)
I confirm that the details in the permit and associated attachments is clear, valid and can proceed further in the PTW process.
Name Company Employee ID Position Date&Time Sign Revert
Budoor Al Breiki ADNOC AD00203402 Engineer, Plant Operations 22/05/2024 06:15 AM Signed

IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSST02-03 | Version No.:01 | Effective Date: April 2019 |Page 1 of 3
SECTION 3 - PERMIT ENDORSEMENT
I have reviewed the workscope and the controls identified to mitigate interface / concurrent activities agree that the work described may be carried out during the proposed period.
Name Company Employee ID Position Date&Time Sign Revert

SECTION 4 - PERMIT APPROVAL

I have reviewed the permit and the attachments and confirm that the described controls are adequate to reduce the risks associated with the work to ALARP. I confirm
that permit can proceed to authorization and work can commence when all the specified controls and precautions are in place.
Validity of Approval Valid From 22/05/2024 07:02 AM Valid Till 29/05/2024 07:02 AM *Mention days if less than maximum limit of consecutive 7 calendar days
Name (Asset Approval Authority-AAA) Company Employee ID Position Date&Time Sign Revert
TL, Production Operations (GAS-
Mubarak Al Mazrouei AD00145735 22/05/2024 07:02 AM Signed
BAB)
SECTION 5 - PERMIT AUTHORIZATION
I have reviewed the permit and the attachments and confirm that the described controls are adequate to reduce the risks associated with the work to ALARP. I confirm
that all pre-requisite wor ksite controls have been implemented as per the requirements of the permit. All precautions will be communicated to the Job Performer (JP) before start of
the work by the PI. There is no geographic or timing conflict with any other Work Permit or activity.
Zero Energy
( if required) ( if not required) ✔ Authorization Delegation ( if delegated to PI for RFO)
Demonstration
Permit Validity Valid From 22/05/2024 07:04 AM Valid Till 29/05/2024 07:04 AM *Mention days if less than maximum limit of consecutive 7 calendar days
Shift Validity Shift From 22/05/2024 07:04 AM Shift Till 22/05/2024 06:59 PM **Date Stamp for first issue only (Specify time slot if required)

Note: In the case of Remote Field Operations (RFO), the zero energy demonstration will be done by delegated personnel with the assistance of other Isolating Authorities. Further AA
authorization requirements shall be done by PI as delegated.
Name (Area Authority) Company Employee ID Position Date&Time Sign Revert
Budoor Al Breiki ADNOC AD00203402 Engineer, Plant Operations 22/05/2024 07:05 AM Signed
SECTION 6 - WORKSITE ISSUE & SUSPENSION
6a. Worksite Re-Validation - Required every shift / work period 6b. Permit Suspension
Area Authority (AA) Permit Issuer (PI) Job Performer(JP) Job Performer(JP) Asset Owner Rep
I accept the worksite as safe to commenc work
and have witnessed Zero Energy (as applicable). I
I have checked worksite will communicate the hazards, permit controls
controls specified on the and conditiions to work party members including I have examined the worksite If not suspended by JP*
I confirm that all Worksite Controls are still in place permit, demonstrated Zero the JSA/Risk Assessment or SHCS requirements and confirm that it has I have examined the
and effective as per the requirements of the permit. Energy (as applicable) & via TBT and remain at workplace for the duration been left in safe condition. I worksite and confirm
There is no geographic or timing conflict with any informed on-site emergency of work. I understand the work hereby suspend the Permit that it has been left in
other Work Permit or activity. instructions to JP. I confirm scope and precautions to be taken. I agree and confirm that my personal safe conditional hereby
work site is safe to commence to abide by the controls and requirements lock has been removed. suspend the permit.
work. described in the permit. I agree to not
commence work unitl clearance has been
provided by the Permit Issuer (PI).
Shift / Validated
Date
Exten Time Time Name & Initials Time Name & Initials Time Name & Initials JP Lock No. Time Name & Initials Time Name & Initials
sion From To

22/05/24 Shift

IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSST02-03 | Version No.:01 | Effective Date: April 2019 |Page 2 of 3
SECTION 7 - PERMIT CLOSURE
7. (a) Permit Return
Worksite clear Yes No Work Complete Yes No Work Continuing under Permit No.
Housekeeping is satisfactory Yes No Permit Cancelled Yes No
Equipment left in safe condition Yes No
Remarks
Equipment ready to return to service Yes No If work is not complete or permit is cancelled, please specify reason
Name (Performing Authority) Company Employee ID Position Date&Time Sign Revert

7. (b) Permit Closure

Worksite clear Yes No Equipment left in safe condition Yes No
Housekeeping is satisfactory Yes No
Name Company Employee ID Position Date&Time Sign Revert

Main Screen Details

Planned Start Date & Time 22/05/2024 07:00 AM Planned Finish Date & Time 28/05/2024 06:59 PM

Location / Equipment

Functional Loc. / Tag No. Equipment ID Description Technical ID Maint. Plant Location (Unit) Plant Section (Area)

OGD I TH "F" TL-1 GI From Area15-

A-ON-1130-TKIG-01 1219 A-ON-1130 TIG
Bb360GI
OGDI TH "F" TL-2 GI From Area15-
A-ON-1130-TKIG-02 1219 A-ON-1130 TIG
Bb365GI
Technical Object ID/Tag No OGDI TH "F" TL-1 GI From Area15- Location( Unit ) Area 15 & Bb 360 GI
Discipline/Department/Work Center Bb360GI
GBB-IF01-Inspection Foreman, GBB Authorization Group Operations
Remote Field Operation Yes ✔ No System Condition In Operation
Created By Mohamed Shafeeq Shihabudheen(CT90007215) Created Date/Time 21/05/2024 03:06 PM
Submitted by Mohamed Shafeeq Shihabudheen(CT90007215) Submitted Date/Time 21/05/2024 03:19 PM

IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSST02-03 | Version No.:01 | Effective Date: April 2019 |Page 3 of 3
 I TOOL BOX TALK RECORD FORM
TBT No. 000000001225636 Permit Type & No. HWP 130000429020 All Personnel involved in the work activities must participate in the Tool Box Talk and sign below as being present.

Discussed Team Members - Attendees

Discussion Points
Yes No Name Discipline Company Signature
Learning from Incidents (LFI) √

Driving √

Manual Handling √

Lifting √

Scaffolding Work √

Work Scope / Limitations √

Life Saving Rules √

Environmental Considerations √

Work At Adjacent Areas √

SIMOPS / Conflicting Activities √

Potential Hazards and Hazardous Materials √

Supplementary Certificates or Associated Permits √

Emergency Preparedness (Alarms, emergency contact
√
details, etc.)
H2S Awareness √

Site Specific Requirements or Rules √

Production or Operational Constraints √

Work Equipment and Tools √

Tests/ Monitoring Requirements √

Access/ Egress √

Individual Roles & Responsibilities √

PPE or Safety Equipment Requirements √

PTW or JSA Controls and Precautions √

Applicable Methods or Procedure √

Other Discussion During the Tool Box

Yes -
Remarks
Action Required
(If any Action)
No - √

Tool Box Talk conducted by:

I confirm that life saving rules, all safety precautions and controls are known and understood by the work team members.

Name Company Employee ID Position Date & Time Sign

Form No.:FM-OSST02-12 | Version No.:01 | Effective Date: April 2019 Page 1 of 1

 VEHICLE AND MACHINE
ENTRY CERTIFICATE CISS
Certificate No. 250000292505 Plant Gas Bab
SECTION 1 - CERTIFICATE APPLICATION
1a. Details of Vehicle Entry 1b. Associated Permits and Certificates
Vehicle / Machine
82017,817611,77498,95536,75571,64388 Permit & Certificate Type Ref Number Status
Number

Make iveco,benz,man,toyota,tadano,crane Hot Work Permit 130000429020 Issue

*1b Details and Status to be Updated by Area Authority
Vehicle / Machine
trailer, pick-up, tanker, hiab, crane, prime mover
Description

Engine Fuel Type Diesel

Purpose of Entry IPS Material Transfer

Location /Worksite Area 15, Bb360 GI

Planned Duration 11 hrs or 6 Days

of Entry (Approx.) Single Multiple ✔
1c.Signature of the Certificate Applicant
Name Company Employee ID Position Date & Time Sign
Budoor Al Breiki ADNOC AD00203402 Engineer, Plant Operations 22/05/2024 07:05 AM Signed
SECTION 2 - SITE PRECAUTIONS
2a.Work Safety Precautions

AA (If PI (if AA( If PI ( If

Details (As Required ) Details (If Required)
Required) Checked) Required ) Checked )

Atmospheric test by Authorized

✔ Others (Specify)
Gas Tester
PI/AGT to accompany vehicle to
✔ Others (Specify)
site

Spark arrestor ✔ Others (Specify)

Chalwyn Valve ✔ Others (Specify)

Flag Man/Rigger ✔ Others (Specify)

Fire extinguishers (Dry Powder at

✔ Others (Specify)
Site)

Specify restrictions for Draining,sampling or venting of gas / hydrocarbon

whilst vehicle engine running.

SECTION 3 - AUTHORIZATION & WORKSITE CLEARENCE

3a. Signature of the Area Authority
I have reviewed and confirm that the controls and precautions identified above are adequate for the safe vehicle entry at the requested work site.
21/06/2024
Certificate Validity: This certificate shall be valid for 30Days Valid From: 22/05/2024 07:05 AM Valid Until
07:05 AM
Name Company Employee ID Position Date & Time Sign

Budoor Al Breiki ADNOC AD00203402 Engineer, Plant Operations 22/05/2024 07:05 AM Signed

3b. Signature of the Authorized person/Permit Issuer

Name Company Employee ID Position Date & Time Sign

Main Screen Details

Planned Start Date & Time 22/05/2024 07:00 AM Planned Finish Date & Time 28/05/2024 06:59 PM

Location / Equipment

IN CASE OF EMERGENCY DIAL : 02-6047666

Form No.: FM-OSSTO2-07 I Version No.: 01 I Effective Date: April 2019 IPage 1 of 2
 Functional Loc. / Tag No. Equipment ID Description Technical ID Maint. Plant Location (Unit) Plant Section (Area)

OGD I TH "F" TL-1 GI From Area15-

A-ON-1130-TKIG-01 1219 A-ON-1130 TIG
Bb360GI
OGDI TH "F" TL-2 GI From Area15-
A-ON-1130-TKIG-02 1219 A-ON-1130 TIG
Bb365GI
Technical Object ID/Tag No OGDI TH "F" TL-1 GI From Area15-Bb360GI Location( Unit ) Area 15 & Bb 360 GI
Discipline/Department/Work Center Inspection Foreman, GBB - GBB-IF01 Authorization Group Operations
Created By CT90007215 (Mohamed Shafeeq Shihabudheen) Created Date/Time 21/05/2024 03:14 PM
Submitted by Budoor Al Breiki (AD00203402) Submitted Date/Time 22/05/2024 07:05 AM

IN CASE OF EMERGENCY DIAL : 02-6047666

Form No.: FM-OSSTO2-07 I Version No.: 01 I Effective Date: April 2019 IPage 2 of 2
 ATMOSPHERIC TEST
RECORD FORM LIVE
Form 280000925282 Plant Gas Bab
SECTION 1 - ATMOSPHERIC TEST RECORD FORM ENTRY DETAILS
Note : Section 1 and Section 2 shall be filled by Area (AA)

Location / Area to be Tested OGD I TH "F" TL-1 GI From Area Attachement (if Any.)

Type Reference # Type Reference #

Permit Ref1 Hot Work Permit 130000429020 Certificate Ref1
Certificate Ref2
Certificate Ref3
Certificate Ref4
SECTION 2 - ATMOSPHERIC TEST REQUIREMENTS

Test Frequency Yes No Required Gases to be Tested Yes No Others (Specify)

Prior to start work Yes ✔ No Oxygen Yes ✔ No
Prior to authorization Yes No ✔ Hydrocarbon Yes ✔ No
Each work period Yes No ✔ H2S Yes ✔ No
If yes, Test Frequency is CO Yes ✔ No
Continuous Gas Monitoring Required (if SO2 Yes ✔ No
continuous, document results prior to work Yes ✔ No
start at each shift) Ammonia Yes No ✔
Locations of Gas Test

SECTION 3 - ATMOSPHERIC TEST RESULTS

Oxygen Hydrocar H2S CO SO2 Ammonia
Material
(%Vol) bon(%lel) (ppm) (ppm) (ppm) (ppm) Testing
Name Employee
Equipment Signature Date Time
Safe
(AGT) No.
>19.5% ID
<5% LEL <5 ppm <25 ppm <2 ppm <25 ppm
Limits <23.5%

Main Screen Details

Planned Start Date & Time 22/05/2024 07:00 AM Planned Finish Date & Time 28/05/2024 06:59 PM

Location / Equipment

Functional Loc. / Tag No. Equipment ID Description Technical ID Maint. Plant Location (Unit) Plant Section (Area)

OGD I TH "F" TL-1 GI From Area15-

A-ON-1130-TKIG-01 1219 A-ON-1130 TIG
Bb360GI
OGDI TH "F" TL-2 GI From Area15-
A-ON-1130-TKIG-02 1219 A-ON-1130 TIG
Bb365GI
Technical Object ID/Tag No OGDI TH "F" TL-1 GI From Area15-Bb360GI Location( Unit ) Area 15 & Bb 360 GI
Discipline/Department/Work Center Inspection Foreman, GBB - GBB-IF01 Authorization Group Operations
Created By CT90007215 (Mohamed Shafeeq Shihabudheen) Created Date/Time 21/05/2024 03:09 PM
Submitted by Budoor Al Breiki (AD00203402) Submitted Date/Time 22/05/2024 07:04 AM

IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSSTO2-05 I Version No.: 01 I Effective Date: April 2019 I Page 1 of 1
 FORMAL RISK ASSESSMENT APPD
RA No. 330000322252 Reference Document No. 330000227163
Work Title PIGGING OPERATIONS FOR TRUNK LINES Location Equipment No Description
Trunk Lines, Production
A-ON-1176-TKPG
Gas
Gas Injection Trunk Lines,
Description of Work CARRY OUT CLEANING, GAUGING AND IPS PIGGING OPERATIONS FOR PRODUCTION/ INJECTION GAS TRUNK LINES A-ON-1130-TKIG
Area 15
Gas Injection Trunk Lines ,
A-ON-1166-TKIG
RMS-6

Tools to be used HAND TOOLS, HAIB TRUCK, PICK UP, CLEANING PIG, GAUGE PIG, PIG MANDRELS, IPS PIGS Work Location classification( where applicable)

Area Classification P/R ✔ NP / UR

Sources of Ignition HAIB TRUCK, PICK UP, PYROPHORIC MATERIAL H2S Zone R A ✔ Y G NC

Hazardous Area
0 1 2 ✔ NC
Classification

Hazardous Materials PYROPHORIC MATERIAL Dust Zone 20 21 22 NC ✔

Involved Risk Level ( Where applicable )

Highest Inherent Risk
Planned Start Date 22/05/2024 07:00 AM H ✔ HM M L
Level
Highest Residual Risk
Planned Finish Date 28/05/2024 06:59 PM H HM M L ✔
Level
Area Classification (P:Process) (R:Restricted) (NP: Non-Process) (UR - Un Restricted)

Planned Start Date & Time 22/05/2024 07:00 AM Planned Finish Date & Time 28/05/2024 06:59 PM Attached Permits 130000429020

Attached Certificates

Other Attachments

IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSSTO3-03 I Version No.: 01 I Effective Date: April 2019 I Page 1 of 6
 PPE Required

Safety glasses ✔ Mitten Body Rescue Stick Impervious Disposal Coverall

Personal H2S Detector ✔ Heat Resistant Gloves Breathing Apparatus Sets (SCBA/SAR) ✔ Emergency Escape Breathing App. (EEBA)

Ear Protection ✔ Pvc Gloves Chemical Mask Lifeine & Harness

Safety Goggles ✔ Electrical Rubber Gloves (LV) Chemical Resistant Apron Shielding For Radiation

Face Shield Chemical resistant gloves Dosimeters Welder's Suit

Eye wash/ body shower Normal cotton gloves ✔ Dust Mask Full Chemical Suit

Full Body Safety Harness Leather Gloves Welding Face Screen / Shaded Glasses Flash Burn Suit

Dust Mask ✔

ADNOC Life Saving Rules

WORK AUTHORIZATION TOXIC GAS BYPASSING SAFETY CONTROL HOT WORK

✔ ✔ ✔
Work with a valid work permit when required Follow the rules for working in toxic gas Obtain authorization before overriding or Control flammables and ignition sources
environments disabling safety control

SAFE MECHANICAL LIFTING ENERGY ISOLATION LINE OF FIRE

✔ ✔ ✔
Plan lifting operations and control the area. Verify isolation and zero energy before work Keep yourself and others out of the line of fire.
begins. Note: The LSR ticked above as a part of JSA shall be
discussed by the Job Performer (JP) at the worksite

CONFINED SPACE DRIVING WORKING AT HEIGHT

✔
obtain authorization before entering a confined Follow safe driving rules Protect yourself against a fall when working at
space. height.

S. Step Pre implementa

Potential Hazards Inherent Risk Ranking Required Controls Residual risk Responsibility Date & Time
No Description requisite tion status

Severity Probability Severity Probability

CHECKLIST IA/JP

IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSSTO3-03 I Version No.: 01 I Effective Date: April 2019 I Page 2 of 6
 FOLLOW PRESSURIZATION PROCEDURE IA/JP
LINE UP
00
OF OVER PRESSURIZATION 3 F 3 A
1
BARREL
CERTIFICATION AND CALIBRATION OF PSV'S IA/JP

CALIBRATED GAUGES IA/JP

ISOLATION CONFIRMATION IA/JP

LINE UP
00 RELEASE OF TOXIC/
OF 3 F FOLLOW PRESSURIZATION PROCEDURE 3 A IA/JP
1 HYDROCARBON GASES
BARREL

PRESSURIZATION WITH NITROGEN/ SWEET GAS IA/JP

KEEP AWAY FROM LINE OF FIRE JP

COLOR CODE OF LIFTING GEARS JP

MOB/ CERTIFIED OPERATOR, RIGGER, BANKS MAN JP

DEMOB
00
AND SITE LIFTING OPERATION 3 F 3 A
2
PREPARA
TION EQUIPMENT CERTIFICATION JP

BARRICADE THE AREA JP

STOP LIFTING OPERATION ABOVE 17 KNOTS JP

DESERT SURVIVAL KIT JP

MOB/ JOURNEY MANAGEMENT JP

DEMOB
00 MOVEMENT OF VEHICLES AND
AND SITE 3 F 3 A
2 EQUIPMENTS
PREPARA
TION PROPER ACCESS AND AGRESS JP

ADSD FOR DRIVERS JP

BUDDY SYSTEM JP

FOLLOW MIDDAY BREAK RULE JP

IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSSTO3-03 I Version No.: 01 I Effective Date: April 2019 I Page 3 of 6
 MOB/
00 DEMOB ADVERSE WEATHER
3 F ADEQUATE SHED AREA 3 A JP
2 AND SITE CONDITIONS
PREPARA
TION
FREQUENT BREAKS JP

CLOSE SUPERVISION JP

USE NON SPARKING PULLING/ PUSHING RODS JP

PIG
LAUNCHI
00 PULLING/ PUSHING OF PIG
NG/ 3 F CONFIRM PIG DIRECTION AND SIZE BEFORE INSERTING 3 A IA/JP
3 MANDREL
RECEIVIN
G
AVOID PINCH POINTS JP

OPEN VENT CONFIRMATION JP

PIG
LAUNCHI
00
NG/ TRAPPED PRESSURE 3 F SAFETY DEVICE CONFIRMATION 3 A JP
3
RECEIVIN
G
KEEP AWAY FROM LINE OF FIRE JP

PIG KEEP WET WITH WATER JP

LAUNCHI
00
NG/ PYROPHORIC MATERIAL 3 F 3 A
3
RECEIVIN
G DISPOSE OFF IN CONTAINER WITH WATER JP

ISOLATION CONFIRMATION JP
PIG
LAUNCHI
00 RELEASE OF TOXIC/
NG/ 3 F FOLLOW DE-PRESSURIZATION PROCEDURE 3 A JP
3 HYDROCARBON GASES
RECEIVIN
G
OPEN VENT CONFIRMATION JP

Endorsement ( Formal Risk Assessment )

Name ( Team Leader ) Company Employee ID Position Date & Time Sign

Adeel Bux AD00151696 21/05/2024 03:16 PM Signed

Team Members

Name ( Team Members ) Company Employee ID Position Date & Time Sign

Mansour Al Rashdi AD00152679 Engineer, Inspection 21/05/2024 03:16 PM Signed

Abdalla Al Naqbi AD00151957 ENGINEER, INSPECTION 21/05/2024 03:16 PM Signed

IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSSTO3-03 I Version No.: 01 I Effective Date: April 2019 I Page 4 of 6
Tareq Alzaabi ADNOC AD00151709 ENGINEER, HSE 21/05/2024 03:16 PM Signed

Abdulla Alebri AD00152596 ENGINEER, PLANT OPERATION 21/05/2024 03:16 PM Signed

Karuppan Samunthan ADNOC CT00050705 21/05/2024 03:16 PM Signed

Management Representatives

Name ( Management Representatives ) Company Employee ID Position Date & Time Sign

Team Members - Contractors

Name Company Employee ID Position Date & Time Sign

Asset Owner Rep Approval: Upon completion of a new risk assessment or enhancements to the existing RA, the standard library is updated post approval from the Asset Owner Rep.

Name Company Employee ID Position Date & Time Sign

Main screen details

Planned start date & time 22/05/2024 07:00 AM Planned End date & time 28/05/2024 06:59 PM
Location / Equipment
Functional location / Tag No Equipment ID Description Technical ID Maint.Plant Location (Unit) Plant Section (Area)

A-ON-1176-TKPG Trunk Lines, Production Gas 1219 A-ON-1176 TPG

A-ON-1130-TKIG Gas Injection Trunk Lines, Area 15 1219 A-ON-1130 TIG

A-ON-1166-TKIG Gas Injection Trunk Lines , RMS-6 1219 A-ON-1166 TIG

Technical Object ID/Tag No Location( Unit ) BAB GAS

Discipline/Department/Work Center Inspection Foreman, GBB(GBB-IF01) Authorization Group Operations

Created by CT90007215 (Mohamed Shafeeq Shihabudheen) Created Date/Time 21/05/2024 03:16 PM

21/05/2024 03:16
Submitted by Mohamed Shafeeq Shihabudheen(CT90007215) Submitted Date/Time
PM

IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSSTO3-03 I Version No.: 01 I Effective Date: April 2019 I Page 5 of 6
 CORPORATE RISK MATRIX
APPD
Term Rare Unlikely Possible Likely Very likely Almost Certain
ERM Criteria Hasn’t happened in the Could be incurred in the next Could be incurred within a 5 Could be incurred within the 5 Could be incurred over the next Could be incurred once or more
industry in the last 50 years 20-30 years -10 year time frame year Strategic Planning period 1-2 year budget period during the next year
HSE Frequency 10-6 ≤ - < 10-5 10-5 ≤ - < 10-4 10-4 ≤ - < 10-3 10-3 ≤ - < 10-2 10-2 ≤ - < 10-1 10-1 ≤ - < 1

HSE Likelihood Has not occurred in worldwide Has occurred in world-wide Has occurred at least once in Has occurred at least once in Has occurred more than once in Has occurred more than once on
industry industry but not in ADNOC the Group Company Group Company but not on the Group Company or once on the the site
site site

Severity Health and Safety Environment Reputation ****Financial Legal # A B C D E F

Inability to comply with laws, regulations or
Multiple public (more than Disastrous effect Prolonged international impact and
Disastrous contracts resulting in substantially material losses.
1) / workers (more than 10) (severe and permanent public attention. Effect will last for years >=$1Billion in a >=$1Billion in a
Disastrous regulatory sanction, prosecution or 6 6A 6B 6C 6D 6E 6F
fatalities or permanent total impacts, consistently and can spread internationally and year year
prolonged multiple litigations. Potential jail terms
disabilities exceeding limits) affect other industry players
for executives
Catastrophic effect
Multiple worker fatalities Serious international impact and public Significantly constrained ability to comply with
Catastrophic (serious impacts on >=$100 million >=$100 million
(upto 10) / permanent total attention - extensive adverse coverage laws, regulations or contracts resulting in material
many attributes of - <$1 Billion in - <$1 Billion in 5 5A 5B 5C 5D 5E 5F
disabilities, or single public in the international media with financial losses. Very serious litigation, including
environment in larger a year a year
fatality potentially severe impact on licenses class actions
area)
Major effect (negative Significant national impact and public
Major Single worker fatality / impacts on surrounding concern - extensive adverse attention in >=$10M - >=$10M - Major breach of law, contract or regulation.
permanent total disability or environment and the national media. Effect could last a <$100M in a <$100M in a External investigation(s), significant regulatory 4 4A 4B 4C 4D 4E 4F
serious injury to public repeated non few months and likely to spread to close year year sanction or major litigation
compliances) industry partners
Serious injuries or health Local effect (reversible Considerable impact - adverse attention Serious breach of law, contract or regulation -
>=$1M - <$10M >=$1M - <$10M
Serious effects (permanent partial impacts but frequent in local media / local government / moderate fines / litigation and / or requires # 3A 3B 3C 3D 3E 3F
in a year in a year
disability) non compliances) action groups reporting to regulator(s)
Minor injuries or health effects Minor effect (impacts Limited impact - some local media
>=$100K - >=$100K - Minor breach of law, contract or regulation where
Minor (reversible effects -weeks to limited organizational / political attention. Effect will last a # 2A 2B 2C 2D 2E 2F
<$1M in a year <$1M in a year mild regulatory sanction or minor litigation
months) surroundings) few days only
Notable Slight injuries or health Slight effect (impacts <$100K in a <$100K in a Low-level legal or business ethics issue; litigation
Slight impact - no public concern # 1A 1B 1C 1D 1E 1F
effects (short term effects) within fence area) year year or regulatory sanction unlikely

Management Signoff
Risk Level Minimum Required Action
Authority
Report immediately upon identification. Must be reduced as soon as possible to As Low As Reasonably Practicable (ALARP) / Management satisfied the costs to reduce the risk exceed the
HIGH / Signoff by Director or
benefits of doing so. Include in Risk Register for tracking. Consider advanced risk methodologies for further investigation. Quantification of **Financial impact, Maximum Foreseeable Loss (MFL)
CATAGORY 1 GC CEO
and Risk Control Effectiveness (RCE) shall be calculated.

HIGHMEDIUM Should be reduced as soon as possible to ALARP / Management satisfied the costs to reduce the risk exceed the benefits of doing so. Include in Risk Register for tracking. Consider advanced Signoff by Unit
/CATAGORY 2 risk methodologies for further investigation. Quantification of **Financial impact, Maximum Foreseeable Loss (MFL) and Risk Control Effectiveness (RCE) shall be calculated. Manager / SVP

MEDIUM / Medium priority, monitor and improve effectiveness of current controls. Include in Risk Register for tracking. Quantification of **Financial impact, Maximum Foreseeable Loss (MFL) and Risk Signoff by
CATAGORY 3 Control Effectiveness (RCE) should be calculated. Dept.Manager / VP
SignOff by Line
LOW / CATEGORY 4 Low priority, monitor and improve effectiveness of current controls.
Manager
*Financial criteria for Operating Companies shall be specified by ADNOC Corporate / for upward reporting Operating Companies shall report against the ADNOC Corporate & Operating Company Financial Consequence levels.
**Financial Impact is the combination of Direct and Indirect costs.
*** For Investments, “Financial” refers to NPV impact.
IN CASE OF EMERGENCY DIAL : 02-6047666 Form No.: FM-OSSTO3-03 I Version No.: 01 I Effective Date: April 2019 I Page 6 of 6