Clssifcaton:inteal Use Saudi Yanbu Petrochemical Company Bagi Contractors Interview Form ei Revlon? yanpat Contractor Interview Form ‘TO BE FILLED BY CONTRACTOR WITH STAMP Contractor Name: ‘Compense atonal igama No Trade: Years of serve Age Endusers departments Date oftheinteniew: | PON: Po validity dete Tnterlaw check it YES [NO [WA | JUSTIFICATION Meeting Minimum Qualifcation as per Gualfeation Matrix “Technically Qualified as per task required for Famllar with required tools to be use in the task Familiar with confined space hazards Familarwith working atheight hazards denied main hazard related to his task nd mitigation ‘Adherence to Safety & Security regustion Adopts an EHSS oriented Behavior Shortcuts, PSA.) ary answers (NO), the esut willbe (FAL wwrewwewsesuar PSO [CE enoust eve. ATONE Interviewer: INTERViEWER NAR EPA Second Level Verification’: [Accented TJ [ReneS FY] scr cam nennen wew 1 Referee Hwonnnnnne WOtROQUIFEG LE] ——_JUBERESRORS naevus TAME DATE 0 POSTION ‘SGRATURE renew C] oid interview reference tn [Previous nienven Date Previous teniewer Rest DATE ‘otto D seton: Form accepted with second level verification Second lve verification tobe dane by |: Tie party department athe ine manager 2 Tumaround & MM Qual Supervisor Incase or emergeney (Oni manager level higher (mstgency deceleration must beatae ‘TASSEORM MUST BE SCANNDED & UPLOADED FOR FUTURE AEEERNCE,