CLIENT Construction of Bitumen Plant and CONTRACTOR

Storage Terminal Facility at Plot Nos.

2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

Excavation Work Permit

SECTION-I: [To be filled by ARIA & ABSW Permit Coordinator]

Permit Ref No. 0000SH2022 W/O No. [If applicable]

SECTION-2: GENERAL INFORMATION [To be filled by Permit Requester]
Contractor AL BARAQ STEEL
Company Date of request 04/ 01 2022
WORKS LLC
Detail
Contractor on-
site
responsible Designation SITE ENGINEER
person RAMESH

name
Contractor on-
On-Site Emergency
site
Contact number
responsible 0505302485
person 0551765533

Contact number

Excavation will be carried out using a combination of excavators with hydraulic rock breaking
Work Description hammers.
Work Location
Plot No. 2M-11A, 13A & 13B Phase I – Hamriyah Free Zone, Sharjah - UAE
Exact Location Hamriyah Free Zone, Sharjah - UAE
Floor Phase I –

From To From To

Date of Work 04/25/2022 07/30/2022 Time of Work 7AM 2PM

Duration of Work 4 MONTHS

SWMS Ref# 0007SH2022 RA Ref#I 00072022

 Yes ◻ No
Other PTW
Interface

Other PTW
interface ref#

SECTION-3: ENTITIES APPROVAL

Drawing
Reference No# ◻ N/A
Authorities
contacted for  Yes ◻ No
latest update on
service location
CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

List of
Underground
services

Clearance
Obtained from  Yes ◻ No ◻ N/A
Authorities

Client informed
and approval  Yes ◻ No ◻ N/A
obtained
EXCAVATOR ◻
 Yes ◻ ◻ ◻ Yes ◻ ◻ Yes ◻ No

◻
TELE-HANDLER Yes ◻ ◻ ◻ ◻ Yes ◻ ◻ Yes ◻ No

◻
Yes ◻ ◻ ◻ ◻ Yes ◻ ◻ Yes ◻ No

◻
Yes ◻ ◻ ◻ ◻ Yes ◻ ◻ Yes ◻ No

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SECTION 7: PTW AUTHORIZATION [To be filled by ARIA & ABSW Permit Coordinator

EMMANUEL KUSIMO 0505302485

QHSE
ARIA & ABSW QHSE DEPARTMENT ENDORSEMENT

Not applicable Not applicable

This section is not applicable during transition period.

◻ ◻

◻ ◻

SECTION – 10: PTW CLOSEOUT [TO BE FILLED BY ARIA & ABSW PERMITS COORDINATOR AND PERMIT RECEIVER)

EMMANUEL RAMESH

04/25/2022 04/25/2022

SECTION – 11: PTW CANCELLATION [ARIA & ABSW AUTHORIZED PERSON)

WORK HAS BEEN EXECUTED

HSE
EMMANUEL
CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

General Work Permit

SECTION-I [To be filled by ARIA & ABSW Permit Coordinator)

0002SH2022
Permit Reference no: I Date of Issuance 04/25/2022

SECTION-2: TENANT AUTHORIZED REPRESENTATIVE FOR FIT-OUT WORK [ To be filled by Fit-Out

Management team)
Name of the firm AL BARAQ STEEL WORKS LLC

Person In-charge RAJESH

Telephone [During I Telephone [After 0509491036

office hours] 0509491036 office hours] I
Email Address

SECTION-3: FIT-OUT CONTRACTOR DETAIL [To be filled by Fit-out Contractor]

Fit-Out Contractor AL BARAQ STEEL WORKS LLC

Company Name
Fit-Out Contractor's
Authorized person [On- RAMESH
Site]
Designation SITE ENGINEER
Authorized person I Authorized
contacts phone no. rameshflashbc@
0551765533 person
Email Address gmail.com
On-site 24 hrs.
Emergency Contact no. 0551765533

Fit-Out Work Floor I Office Number [if

applicable]
FIT-WORK CONTRACTOR EMERGENCY CONTACT DETAIL [To be filled by Fit-out Contractor]
Telephone/Mobile Numbers
S.no Name
During office hours After Office
hours
RAJESH 0509491036 0509491036

RAMESH 0551765533 0551765533

EMMANUEL 0505302485 0505302485

CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

SECTION-4-HIGH RISK AND SPECIALIZED ACTIVITIES PERMIT REQUIREMENT

Note:
1. If any task contains the following high risk and/or specialized work? [A specific Permit to
Work must be obtained prior to the commencement of the task]
2. Failure to obtain necessary permit to work for the high risk/specialized task will result in the
termination of work and cancellation of GWP.

High Risk Work Contained Permit to Work required

Access to roof ARIA & ABSW Roof Access Permit □

Any task includes lifting operation by hoist, lift, cranes,
sling, hooks, eyebolt ARIA & ABSW Lifting Operation Permit □
Any task carried out using Boom lift, Man lift, Genie
lift, Scissor lift etc. ARIA & ABSW MEWP Permit □

Any task in a space which is substantially enclosed

[though not always entirely), and where serious ARIA & ABSW Confined Space Permit □
injury can occur from hazardous substances or
conditions within the space or nearby [e.g., lack of
oxygen)
Work includes but not limited to welding, brazing, ARIA & ABSW Hot Work Permit □
soldering,
use of angle grinder or any other work that creates
heat or sparks
Any task carried above three meters from the ARIA & ABSW Height Work Permit □
ground level using any access equipment
Any task that made hole in earth or face of earth, ARIA & ABSW Excavation Permit □
formed after
rock, sand, soil or other material removed which is
greater than or equal to 30cm depth
Any task on electrical system where there is a ARIA & ABSW Electrical System Permit □
possibility of contacting with energized electrical
conductor
Specialized Work Contained Permit to Work required □
Partial or Full Isolation of any Life safety system ARIA & ABSW Impairment of Life Safety System
[e.g., Fire Alarm, Fire Fighting, Central Battery Permit □
System etc.)
Accessing of hazardous cylinders [compressed gas ARIA & ABSW hazardous cylinder access permit □
cylinder, LPG cylinder, acetylene/oxygen cylinder
etc.,)
Any alteration in base built design ARIA & ABSW base-built alteration form □
CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

SECTION-5: DOCUMENTS REQUIREMENT

[A soft copy of following work-related documents to be attached along with this permit)
Documents required Attached Not Not
Attached Applicable
Fit-Out Contractor company Trade License
◻ ◻ ◻
Fit-Out Permit from Authorities [DDAJ
◻ ◻ ◻
Work specific HSE Plan
◻ ◻ ◻
Work ahead Plan for Fit-Out work [Stage by stage Plan)
◻ ◻ ◻
Safe Work Method Statement [SWMSJ for all task related to Fit-
Out work ◻ ◻ ◻
Risk Assessment [RAJ for all task related to Fit-Out work
◻ ◻ ◻

Fit-Out Waste Management Plan

◻ ◻ ◻
Work Place Fire Protection plan
◻ ◻ ◻
Fit-Out contractor Emergency Escalation Matrix
◻ ◻ ◻
First Aider Competent certificate
◻ ◻ ◻
First Aid Box Inspection checklist
◻ ◻ ◻
Material Storage Strategic Plan
◻ ◻ ◻
Safety Data Sheet [SDSJ/COSHH assessment for hazardous
substances ◻ ◻ ◻
Fit-Out contractor's competency certificate 6: Legal documents
[if any), in case their work required to comply with legal
◻ ◻
requirement? ◻
[E.g., Scaffolder erector/Inspector certificate, welder competent
certificate, Fire Watch Certificate etc., authorized by Local or
International authorities)
Fit-out Management 6:
Coordination team RAJESH Signature/
Authorized person Name Date

Fit-Out Contractor's Authorized Person Name RAMESH Signature/Date

CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

SECTION 1 :[To be filled by ARIA & ABSW Permit Coordinator]

0003SH2022

AL BARAQ STEEL WORKS 04/25/2022

RAMESH SITE ENGINEER

0551765533 0505302485

WELDING AND GAS CUTTING

PHASE 1 Hamriyah Free Zone Sharjah.

784198780 0505302485

04/25/2022 04/30/2022 7AM 2PM

4 MONTH

0004 000810
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003SH2022

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CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

◻ ◻

◻ ◻ ◻ ◻
◻ Safety Gloves ◻ ◻ ◻

[To be filled by ARIA & ABSW Permit Coordinator]

EMMANUEL KUSIMO 0505302485

HSE

ARIA & ABSW QHSE Department endorsement

Not applicable Not applicable

This section is not applicable during transition period.

RAMESH 0551765533
AL BARAQ STEEL WORKS LLC

◻ ◻ ◻ ◻

◻ ◻ ◻ ◻
◻ ◻
SECTION – 7 PTW CLOSEOUT [TO BE FILLED BY ARIA & ABSW PERMITS COORDINATOR AND PERMIT RECEIVER)

EMMANUEL KUSIMO RAMESH

SECTION – 8 PTW CANCELLATION [ARIA & ABSW AUTHORIZED PERSON)

CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

Lifting Operation Permit

SECTION-I: [To be filled by AIRA & ABSW Permit Coordinator]

Permit Ref No. 0000SH2022 W/O No. [If applicable]

SECTION-2: GENERAL INFORMATION [To be filled by Permit Requester]

Contractor Company AL BARAQ STEEL WORKS Date of request 04/25/2022

Detail LLC
Contractor on-site
responsible RAMESH Designation SITE ENGINEER
person name
Contractor on-
On-Site Emergency
site 0505302485
0551765533 Contact number
responsible
person
Contact number
Work Description LOADING OF SHEETS INTO TRUCKS
Work Location Plot No. 2M-11A, 13A & 13B Phase I – Hamriyah Free Zone, Sharjah - UAE
Exact Location
Floor

From To From To
Date of Work Time of Work
04/25/22 4/30/22 7AM 2PM

Duration of Work 4 MONTHS

SWMS Ref# SH0001 RA Ref# SH0022022

Other PTW Interface ◻ Yes ◻ No

Other PTW 0006

interface ref#
SECTION-3: LIFTING PLAN REQUIREMENT

Description of Load SHEETS I Lifting plan Ref# 00012022

I
Overall Dimensions

◻ known weight ◻ Calculated/Estimated weight

Weight of load
Explain how much Kg? I Explain how much tone?
SECTION-4: DETAILS OF LIFTING EQUIPMENT
Type of
Lifting MOBILE CRANE
equipment
Safe working 25 TONS I Last 04/10 2023
Load certification date
Lifting gears certification ◻ Yes ◻ No
verified
LIST
LIST OF LIFTING GEARS TYPE SWL OF TYPE SWL
LIFTIN
G
GEARS
Lifting gear 1
Lifting gear 4
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SECTION 9: PTW AUTHORIZATION [To be filled by ARIA & ABSW Permit Coordinator]

Not applicable Not applicable

This section is not applicable during transition period.

◻ ◻

◻ ◻

SECTION – 12 PTW CLOSEOUT [TO BE FILLED BY ARIA & ABSW PERMITS COORDINATOR AND PERMIT RECEIVER)

SECTION – 13 PTW CANCELLATION [ARIA & ABSW AUTHORIZED PERSON)

MOBILE CRANE LIFTING PERMIT

DATE APPLIED 04/ 25/ 2022 MSRA Ref: SF 25 00 PERMIT NO…0002

VALID TIME Company: AL BARAQ WORKS LLC

04/25/2022
FROM DATE FROM 7AM Worksite: Plot Nos. 2M-11A, 13A & 13B,
TO DATE 04/30/2022 TO 2PM Area: Phase I – Hamriyah Free Zone, Sharjah.
DESCRIPTION WORK TO BE DONE

LIFTING AND LOADING OF SHEETS INTO A TRUCK

Type of MOBILE Maximum

Lifting Maximum 31.5M radius/Inten 10 M SWL at this 90 degree
CRANE
Equipment/C 25TONS Boom/Jib length ded load (Distance between radius
apacity: radius the load & crane)

SAFETY PRECAUTION Yes No SAFETY PRECAUTION Yes No

Pre-check has been done for the erection area Lifting area is barricaded

Shape of the load is accepted for lifting No other equipment working within the barricaded area

Load is visible by the crane operator S.W.L. / Load chart at the crane is known to the operator

Trained and certified Banks-man / rigger provided All limit switches at the crane / hoist are functioning

Guide rope is provided with the load Crane is checked and fit for working (Tower / Mobile)
Lifting operation is being carried out under the Supervisor / Third party certificate for the crane / hoist & lifting
Engineer appliance are available

Ground status is checked and found suitable for lifting by

Crane operator license and 3rd Party certificate are valid
crane

Lifting Supervisor: Issued by ABSW & AIRA Project (PM/CM)

Name Requested: Name: EMMANUEL KUSIMO

Signature: Date: 04/25/2022 Signature: Date: 04/25/2022

Work area is inspected, and safety precautions listed Work area is inspected, and we certify that the
in this permit must be followed working area is safe and protected
Recommendation/Comment from:
ABSW SAFETY Officer I acknowledge the precautions to be taken and accept the responsibility of
Name: EMMANUEL KUSIMO carrying out the job accordingly
Name of Receiver: RAMESH
Signature: Date:04/25/22
Supervisor Signature: Date: 04/25/2022
PREVENTATIVE MEASURES TO BE TAKEN:

All workers that are performing work on this permit have to sign on that they understand the work to be
performed and that they will use there safety equipment
Name Signature Name Signature
1 ARVIND NISHAD 2 AKABAR ALI AOLI
3 SURESH HUMAR 4 SAMI ULLAH
5 6
7 8
I acknowledge that the work is completed and the The work is completed & waste material
working area has been cleared from any hazard related removed. (ABSW:SO /ARIA SO)
to my work.

Supervisor Signature: Date: Signature Date: 04/25/2022

04/25/2022
MOBILE CRANE LIFTING PERMIT

MOBILE CRANE LIFT CALCULATIONS

To be used for all lifts to 10 ton complete each time crane is set up at new location. Calculation based on maximum planed lift
weight and radius at current set up.
Setup Checklist
(To be completed by the crane operator)
Sl No Description Yes No
01 Crane set on level ground and out riggers are fully extended? 
02 Pick up and drops paths identified? 
03 Rigging equipment inspected and correctly colour coded? 
04 Is the lift area around the crane controlled? 
05 Daily crane checklist complete and safe to commence work? 
**if any answer is No any of these questions, Do not commence lift **
CALCULATION LIFTING CAPACITY AS
PER THE LOAD CHART
A (Boom)= 31.5 meter

B (Radius)= 8.4 meter

C (Ancillaries Weight) = 10 ton

D= 0-2t, 2-4t, 4-6t, 6-8t, 8-10t

Total Weight (C+D) = 15

MAXIMUM LIFTING CAPACITY

At Crane Set up
20
Ton
Current % Crane Capacity
25 %
SIGN OF SECTION
Crane Operator: SAMI ULLAH ASIF Competent Rigger: ARVIND NISHAD
ID No: 784199826280515 ID No: 784200084375102
Time & Date 7AM TO 2PM, 04/25/2022 Time & Date 7AM TO 2PM, 04/25/2022
Supervisor: Time & Date
Crane Type MOBILE CRANE Crane Make: KATO Crane Model:BOOM
CRANE
CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

◻ ◻

◻ ◻
SECTION-5: OVERHEAD SERVICES
◻ No [Safe to proceed]

Are there any overhead obstructions? ◻ Yes [Do not perform the task until the obstruction is cleared/ isolated]
Job specific PPE/Safety equipment requirements:
Safety Helmet ◻ Safety Goggles ◻ Safety Harness ◻
Safety
Ear Plug/Ear Muff ◻ Safety Gloves ◻
Shoes
Specify here:
Others ◻

SECTION-6: PRE-TASK CHECK [Mandatory Work Site Inspection Required]

Yes N/A Y N
e /
s A
SWMS 6: Risk Assessment briefed to all Instructions not to leave the basket/platform
the employees durinq TBM ◻ ◻ whilst ◻ ◻
elevated
Operators trained in the use of full body
Equipment positioned on a firm level ◻ ◻ safety ◻ ◻
surface harnesses
Proper means of lowering the Ensure that no overhead structures are
equipment been ◻ ◻ present in ◻ ◻
determined the swing area
Operators instructed that all materials
and Availability of appropriate safety
◻ ◻ equipment? [E.g. certified harnesses, ◻ ◻
hand tools not in use whilst aloft to be
contained within the handrails lanyards, and securing points]
Lifting area barricaded 6: no equipment
working within the barricaded area ◻ ◻ All limit switches are functioning ◻ ◻
SECTION-7: PTW AUTHORIZATION [To be filled by ARIA & ABSW Permit Coordinator]

Based on the information provided in above sections, I am authorizing this PTW given that all the precautions are
adhered to.
Issuer Name Mobile

Designation 6: Signature
Company
SECTION-8: PTW ACCEPTANCE [To be filled by Permit Receiver]
I understand the hazards associated with work and its precautions as stated during the Risk Assessment. I
am accepting the conditions of this PTW and I will be responsible for ensuring that all stated HSE precautions
are in place and adhered to.
Receiver Name Mobile

Designation 6: Signature
Company
SECTION-9: POST TASK CHECK [Mandatory Work Site Inspection Ye N/A Comments
Required] s
Area returned to its normal condition ◻ ◻

The work platform has been lowered ◻ ◻

SECTION-IO: PTW CLOSE OUT [To be filled by ARIA & ABSW Permit Coordinator and Permit Receiver]
We declare that the task described above and to which this PTW is issued has been completed 6: the work area,
associated systems/equipment are returned to its normal state
PTW Issuer Name 6:
Signature I PTW Receiver Name 6:
Signature

Date 6: Time Date 6: Time

SECTION-11: PTW CANCELLATION [ARIA & ABSW Authorized Person]

Reason for
cancellation
Cancelled by Designation

Date Signature
CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

Height Work Permit

SECTION-I: [To be filled by ARIA & ABSW Permit Coordinator]

Permit Ref No. W/0 No. [If applicable]
SECTION-2: GENERAL INFORMATION [To be filled by Permit Requester]
Contractor Company Date of request
Detail
Contractor on-site
responsible person Designation
name
Contractor on-site
On-Site Emergency
responsible
Contact number
person Contact
number

Work Description

Work Location

Floor Exact Location

From To From To
Date of Work Time of Work

Duration of Work

SWMS Ref# RA Ref#

Other PTW Interface ◻ Yes ◻ No

Other PTW interface ref# I
SECTION-3: HEIGHT WORK TYPE
Please select the type of height work

◻ Ladder [fill section 5 6: then 9 onwards] ◻ Scaffolding [fill section 6 6: then 9 onwards]
◻ Suspended Access Equipment [fill section 7
6: then 9 onwards] ◻ Rope Access [fill section 8 onwards]
SECTION-4: ANEMOMETER REQUIREMENT
Is the Anemometer Calibrated ◻ Yes ◻ No Next Calibration Date

Calibration Company Accredited by ◻ EIAC

SECTION-5: LADDER
Yes N/A Yes N/A
Metal ladders not
ladders are in good working ◻ ◻ used in or near ◻ ◻
electrical cabling or
circuitry

Copyright © ARIA & ABSW. All rights reserved.

Height Work Permit Page 1 of 3 Approved by:
QHSE Manager
◻ ◻ ◻ ◻

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Copyright © ARIA & ABSW.

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[To be filled by ARIA & ABSW Permit Coordinator)

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SECTION – 13 PTW CLOSEOUT [TO BE FILLED BY ARIA & ABSW PERMITS COORDINATOR AND PERMIT RECEIVER)

SECTION – 14 PTW CANCELLATION [ARIA & ABSW AUTHORIZED PERSON)

Copyright © ARIA & ABSW.

CLIENT Construction of Bitumen Plant and CONTRACTOR
Storage Terminal Facility at Plot Nos.
2M-11A, 13A & 13B, Phase I –
Hamriyah Free Zone Sharjah.
EBS GPG ARIA AL BARAQ STEEL WORKS
FZE LLC

Confined Space Work Permit

SECTION-I [To be filled by ARIA & ABSW Permit Coordinator]

W/O No. [If

Permit No. applicable]
SECTION-2: GENERAL INFORMATION [To be filled by Permit Requester]
Contractor
Date of
Company Detail
request
Contractor on-
site Designation
responsible
person
name
Contractor on- On-Site
site Emergency
responsible Contact
person number
Contact number

Work Description

Work Location
Floor Exact
Location
From To From To
Date of Work Time of
Work

Duration of Work

SWMS Ref# I RA Ref#

Other PTW Interface ◻ Yes ◻ No
PTW Interface Ref# I
SECTION-3: AIR QUALITY TESTING - Gas monitoring must be repeated and the results recorded in gas
monitoring log sheet at regular intervals whilst personnel are in the confined space.

Date Time

Instrument used Brand 6: Model#

Date of Calibration Calibration Company

Oxygen Level [Safe Limit 19.5% to Flammable gas % [ <5% LEL]

23.5%]
Carbon Monoxide [ <35 PPM for 8 Hydrogen Sulphide
hours]
Carried Out by Designation

Mobile Signature

Copyright © ARIA & ABSW All rights

Confined Space Work Permit Page 1 of 3
reserved.
Approved by:
QHSE Manager
◻ ◻

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SECTION 6: PTW AUTHORIZATION [To be filled by ARIA & ABSW Permit Coordinator]

ARIA & ABSW QHSE ENDORSEMENT

Not applicable Not applicable

This section is not applicable during transition period.

◻ ◻ ◻ ◻

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◻ ◻

SECTION – 9 PTW CLOSEOUT [TO BE FILLED BY ARIA & ABSW PERMITS COORDINATOR AND PERMIT RECEIVER)

SECTION – 10 PTW CANCELLATION [ARIA & ABSW AUTHORIZED PERSON)

PRESSURE TEST

DATE APPLIED / / PERMIT NO…………..

VALID TIME Work Site:

FROM DATE FROM Area:

TO DATE TO Line No:

DESCRIPTION AND AREA WHERE WORK IS TO BE DONE (Indicate either Hydrostatics or Pneumatic Test

SAFETY PRECAUTION Yes No SAFETY ITEM CHECKLIST Yes No

Approved risk assessment/method statement
Are pressure gauges fitted where required?
is attached?
Responsible Person designated? Are calibration certificates supplied?

Is an Isolation permit required? Adequate drain cocks

Test area adequately identified with signs &
Have all blank / plug / seal off’s been installed?
cleared of personnel?
Have non-essential items been removed or Emergency Numbers and appropriate signage
blanked off? placed
Have all valves been closed at limits of test
Adequate illumination provided
section?
Have all high point vents been closed? Other Control Measures
Supervisor/ Foreman Issued By ABSW/ARIA Project (PM/CM)
Name Requested: Name:

Signature: Date: Signature: Date:

Work area is inspected and safety precautions listed in Work area is inspected and we certify that the
this permit must be followed working area is safe and protected
Recommendation/Comment from:
ABSW/ARIA/ Safety Officer I acknowledge the precautions to be taken and accept the responsibility of
carrying out the job accordingly
Name:
Name of Receiver:
Signature: Date:
Supervisor / Foreman Signature: Date:
PREVENTATIVE MEASURES TO BE TAKEN:

All workers that are performing work on this permit have to sign on that they understand the work to be performed
and that they will use there safety equipment
Name Signature Name Signature
1 2
3 4
5 6
I acknowledge that the work is completed and the working The work is completed & waste material
area has been cleared from any hazard related to my removed. (ABSW/ARIA /SO)
work.
Requested
Supervisor Signature: Date: Signature Date:
Work Permit for Temporary, Formwork and False work
To be completed by a Construction Manager / Site Engineer: Name: _ _

Name of Project: Date:

Type of structure: (slab, Colum, wall etc) Area / Location of Structure:

Drawing Reference: In House Inspection ( ) or 3rd Party Inspection ( ) Tick one

MSRA Ref:
Permit Date: Permit number:

Person
No: Permit to load Stages Yes No If NO what action need to control
Responsible
Have all drawings and calculations been
1 If No, do not proceed
approved?
If No, ensure sub-contractor is Competent
2 Is formwork being erected by ARIA? and have a method of checking formwork
before pouring starts?

3 Are personnel trained?

4 Are all materials used free from defects?

Risk assessment and Method statement
5
in place?
6 Is there adequate access to formwork,
working area, ie scaffold, ladder.
This is to certify that the loading stages above have been checked and completed.
Name of Construction Manager / Project Manager _ _

Signature: Date:
PERMIT TO STRIKE (completed by CM or Engineer)
Person
No: Permit to Strike Stages Yes No If NO what action need to control
Responsible
1 All loading complete?
2 Concrete cured as per design?
3 Safe access & egress to place of work?
4 Edge protection in place?
5 Is there a need to back prop?
6 If back propping, is it as per design?
This is to certify that the striking stages above have been checked and completed.
Name of Construction Manager / Project /Site Engineer

Designation: Signature: Date & Time

Safety: Signature: Date & Time

Close out of PTW: this is to confirm that the striking stages has been completed & area is safe and clean

Name of Construction Manager / Project /Site Engineer:

Designation: Signature: Date & Time :

Safety: Signature: Date & Time

COLD WORK PERMIT

CONTRACTOR: PERMIT REF. NO: ISSUE DATE:

LOCATION: NO. OF PERSONS ON JOB:

DESCRIPTION OF WORK:

HSE personal protective equipment and precautions to be taken and inspected prior to job start:
Goggles, safety spectacles, face mask, Face shield  YES  N/A
Hand gloves, PVC gloves  YES  N/A
Ear muffs, ear plugs  YES  N/A
Chemical suits, apron or protective clothing  YES  N/A
Safety belts, harness  YES  N/A
Area Identified Flagged Off  YES  N/A
Method statement (or JHA) approved  YES  N/A
Tool box talks conducted  YES  N/A
Standby man required  YES  N/A
If Elevated Work, Scaffold/Ladder Provided& Inspected  YES  NO
SPECIAL SAFETY PRECAUTIONS:

(foreman/Supervisor )
SIGNATURE NAME (PRINT)

(Project Manager/ Construction

Manager)
SIGNATURE NAME (PRINT)

(HSE APPROVAL)
SIGNATURE NAME (PRINT)

PERMIT VALID FOR:  ONE DAY  ONE WEEK (7 DAYS)

(PERMIT VALIDITY TO BE SPECIFIED BY ACCORDING TO TYPE OF JOB AND SITE CONDITIONS)

PERMIT SHALL BE SIGNED OFF, UPON COMPLETION OF THE JOB OR PRIOR TO END OF WORK SHIFT, WHICHEVER COMES FIRST.
 JOB COMPLETE  INCOMPLETE CLOSING DATE:

(CONTRACTOR)
SIGNATURE NAME (PRINT)
NOTE: 1. A COPY OF THIS PERMIT SHALL BE DISPLAYED AT THE WORK SITE.
2. PERMIT MAY BE CANCELLED WITHOUT NOTICE AT ANY TIME.
3. A COPY OF THE COMPLETED PERMIT MUST BE KEPT ON HSE FILE IN THE SITE OFFICE

PAGE 1 OF 1
RESTRICTED ENTRY PERMIT
Project: BRICKSTONE HSE Ref. No.
Location: MSRA Ref: Date: Time:
PERMIT
Permit
FOR PERMIT NO.
(Company) Validity

Section - I (To be filled by the Permit Holder)

ARIA / ABSW (Specify):
Nature of work:

Permit requested by- (Name): Designation:

Sl.no Safety requirements to be checked by Permit holder Yes No

01 Proper PPE provided for the job (General & Task Based)
02 Equipment and tools in good condition / certified
03 Sufficient lighting, ventilation and exclusion zone above and below area.
04 Proper electrical connections and cable management.
05 Skilled and authorized workers and work briefing done
06 Competent supervision at all times
07 Area clean and barricaded, nobody can fall through floor or wall opening.
08 Inspected and tagged scaffolding with proper working platform
09 Risk assessment communicated, Task briefing conducted and recorded by the supervisor
All the above points checked and found satisfactory

Name and signature - Engineer Name and signature - Safety Officer

(Sub Contractor) (Sub Contractor)
Name and signature - Engineer Name and signature - Safety Officer
(Sub-Contractor) (Sub Contractor)
Section - II (To be filled by the Permit Issuer)
Sl.no Safety requirements to be checked by Permit issuer Yes No
01 All requirements as per Section I to be followed
02 Any changes in the above makes this permit invalid.
03 All concerned parties to be communicated (as per Section I - 09)
04 Proper supervision (as per Section I - 06)
In case of any change / work extension please contact permit issuer:

Permit is valid up to (Date and Time) : / _ / Time : AM / PM

Name and signature – ARIA (CM) Name and signature - Safety Advisor /Officer (ABSW.)
Section-III (Closure of permit By permit Holder)
Sl.no Safety requirements to be confirmed by Permit holder Yes No
01 Work finished Safely and area now in safe condition.
02 All excess materials, equipments removed and housekeeping done
03 All concerned parties have been notified.

Page 1 of 2
RESTRICTED ENTRY PERMIT
Project: HSE Ref. No.
Location: MSRA Ref: Date: Time:

I hereby confirmed that all requirements by me as per this permit are fulfilled.

Name and signature - Engineer Name and signature - Safety Officer

(Sub Contractor) (Sub Contractor)

Name and signature - Project Engineer () Name and signature - Safety Officer ()
Workers Details
Sr. Name Trade Tally No. Signature

Restricted Area Permit Inspections

Sr. Time Name Designation Signature

Page 2 of 2