SAYED KHADEM AL DURAZI & SONS

HEALTH AND B.S.C.(c)

SAFETY DEPARTMENT
EXEMPTION FROM USE OF REQUIRED SAFETY EQUIPMENT(S)

This is to certify that the employee listed below, is exempted from using the
following safety equipment as indicated. This exemption is valid only within
SKD premises and official SKD work sites unless otherwise stated. Please take
note of Validity and follow accordingly.
Name: FILE NO.
Designation: Age Nationalit
: y:
Commenceme Expires
nt: on:
EXEMPTED FROM THE USE OF: (Tick mark denotes exemption and X mark for no
exemption)

BOOTS/SHOE
HARD HAT GOOGLES CLOTHING GLOVES RESPIRATOR FACESHIELD EAR MUFFS HARNESS
S

Basis for exemption:

____Sayed Nizar____ ____________________________

Health and Safety Department Head Supervisor (Name and Signature)

______________________________ _____________________________
Nurse (Name and Signature) Employee Signature