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General Work Permit Emergency

This document outlines a General Work Permit for manual excavation and backfilling related to HDPE pipeline rectification, detailing the requestor, contractor, work description, and safety requirements. It includes sections for documentation review, safety checks, joint site inspection, and permit closure. The permit is valid for 15 days, with specific safety measures and personnel involved in the process.

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Umair
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10 views

General Work Permit Emergency

This document outlines a General Work Permit for manual excavation and backfilling related to HDPE pipeline rectification, detailing the requestor, contractor, work description, and safety requirements. It includes sections for documentation review, safety checks, joint site inspection, and permit closure. The permit is valid for 15 days, with specific safety measures and personnel involved in the process.

Uploaded by

Umair
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 3

NEOM Operations –Public

Facilities Management
General Work Permit

Permit No.: Date Applied:

DOCUMENTATION REVIEW
Section – I General Information
Permit Category Standard Operational Emergency / Urgent
Work
Requestor Name Mukhtar Location
Minor Work
Contractor Name Order # (If
NDC any)
Work Description Manual Excavation & Backfilling for the rectification of HDPE Pipeline
Total
From (Date) To (Date)
Work Permit Days 15
Coverage To Total
From (Time) 7:00 Am 5:00pm 12
(Time) time
Associated Permit (If
required)

Section – II Safety Requirement


All requirements mentioned below shall be completed and verified. If “Not”, please “Do Not” proceed.
Yes No N/A Yes No N/A
Does the work require announcement to
1
the community? Toolbox talk conducted before
9
Risk assessment and method statement commencing the activity?
2
approved and provided?
Work area barricaded/ isolated with proper All mandatory PPEs provided, checked
3 10
signage? and in good conditions?
Safe Workplace regard to Lighting,
4 Weather conditions suitable to execute
ventilation, and access?
11 the work?
Services isolated and locked as per LOTO
5 Hand and power tools inspected, tagged
procedure if required? 12
and in good condition?
Adequate access provided for pedestrian
Multipurpose fire extinguisher provided 13
6 and utility services vehicles?
and available nearby?
14 Drinking water and rest area provided?

Employees aware of nearest exit and 15 First Aid Kit available at site?
7 emergency assembly point location?
Others
Chemicals to be used have MSDS /
8 COSHH present?

Personnel Protective Equipment (PPE) Hard Safety


Vest Goggles Respirator
Hat harness
Others (please specify).
Safety Shoes Safety gloves Coverall

Section – III Permit Requester


I have personally inspected to ensure that all requirements & precautionary measures as mentioned above have been fulfilled.
Name Mukhtar Email [email protected]
Signature
Designation SITE Manager Mobile No. 0538815586
Contractor NDC
Contractor Safety Personnel
Name Umair Tariq Mobile No. 508385970
Email [email protected] Signature
Section – IV NEOM Proponent / Stakeholder

Page 1 of 3

Public
NEOM Operations –Public
Facilities Management
General Work Permit

NEOM Proponent
Muhammad.kamran@neo 0594147373
Name Muhammad Kamran Email Mobile No.
m.com
Designation Landscaping Engineer Signature Remarks
Other NEOM Stakeholder/s
Name Email Mobile No.
Designation Signature Remarks
Name Email Mobile No.
Designation Signature Remarks

Section – V NEOM FM H&S Dept.


Remarks:
Name Email
Mobile
Designation Signature
No.

JOINT SITE INSPECTION


Section VI Joint Inspection (Onsite)
Work will only commence after a HSFA site visit ensuring compliance with section II of the PTW and the controls advised within
the Risk Assessment & Method Statement (RAMS)
Remarks:

Permit Requester NEOM Proponent NEOM FM – H&S


Name Name Name

Signature/Date Signature/Date Signature/Date

Section – VII Holding/ Stoppage of Work

Reason (Holding / Stoppage) Stopped by Time Informed to Restarted time Signature

Section – VIII Extension


The work is not completed, and the renewal of permit requested for additional hours.
Reason for extension
From Total
Additional days To (Date)
(Date) Days
From To Total
Additional hours
(Time) (Time) time
Requester
Name Email Mobile No.
Signatur
Designation Remarks
e
Approval (NEOM Proponent)
Name Email Mobile No.
Signatur
Designation Remarks
e
Approval (FM-H&S)
Name Email Mobile No.
Signatur
Designation Remarks
e
Section – IX Permit Closure

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Public
NEOM Operations –Public
Facilities Management
General Work Permit

Note: I hereby confirm the completion of the work and any alarm, electrical, valves, etc. isolations/ LOTO have been removed.
Work area is cleaned, tidy and safe for operational use.
Permit Requester NEOM Proponent FM – H&S
Name Name Name

Signature / Date Signature / Date Signature / Date

Page 3 of 3

Public

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