Official Form

NEOM OPERATIONS – FACILITIES MANAGMENTS

GENERAL PERIMT TO WORK

"This GENERAL Permit to Work is required only for Low Risk Activities."
ENSURE PRECAUTIONS ARE IN PLACE!
MAKE SURE AREA OF WORK WAS ISOLATED, SPRINKLERS ARE IN SERVICE AND FIRE EXTINGUISHERS ARE READILY AVAILABLE!
Note: The required Precaution are not optional. They are required for safe work. Please explain all “NO” responses in the back.
Valid From Valid to Time Start Time of Completion

Tool / Equipment to be used: ________________________________________ Means used to restrict the access of unauthorized personnel from the wok area :

________________________________________________________________ Signs / Tags Barricades Isolation Other:_______________________

PPE Required:
Person(s) doing the work has / have been attended to safety orientation course? Hearing Protection. Face Shield.
Risk assessments and mothed statements (RAMS) has been completed for this work?
Used tools and equipment are in good condition? Gloves. Safety Glasses.
Does the work involve high noise?
Does the work involve using hazardous material? (If “YES” attached the SDS of hazardous High visibility jacket. Hard hat.
material)
Respirator Mask. Safety Shoes.
Does the work involve blocking egress routes? (If “YES” attached location of new egress
route and emergency exits)
Special Tools and Equipment Required Needed: : __________________________
Does the work involve cranes / overhead load movement? (If “YES” attached crane /lifting
permit)
Underground / under walls utilities (Piping, Electric etc.) located, verified and marked?
Does the project involve disabling services (Power, Water , Sewage)?

General Safety Rules: Fire and Evacuation:

 The Permit to Work can be cancelled by FM health and safety auditors in case the laid –down
precaution and safety measures are not being followed. Fire Extinguishers required? Fire procedure understood?
 Contractor should not obstruct traffic inside and outside Neom operations.
 Put safety signs and warning signs at the entrance of working area. Fire Blanket required? Location of nearest fire alarm known?
 Contractor must isolate work area from the rest of the building.
Clean Agent System / Sprinkler in service? Escape routes maintained and known by
 Contractor must ensure no dust or smoke seep to outside area of work.
Person
 All debris must be removed from within buildings in closed containers.
 All debris must be keep in contractor’s containers.
Official Form
Name Signature Date Mobile Email
Permit Holder Name and Signature
Approvals and Signatures
NEOM operation H&S /Reps.
NEOM operation proponents
Other NEOM proponents (if Any)

PERMIT TO WORK CLEARANCE

Details any incomplete work here:_________________________________________________________________________________________________________

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I assure that the site has been left in a safe condition and clean with any necessary locks. Removed, PTW holder Signature Date
the system tested and is in good condition and I’m aware about the incomplete work noted above.
Neom Ops Proponent Signature Date FM H&S Signature Date
Official Form
FM H&S must:
a) Verify precaution listed at the back (or do not proceed with the work.
b) Complete this page and give original copy to permit Holder to put in work area.
c) Give copy of this page to Neom Operation representative Department.

PTW holder must: Indicate date started and post the permit at location. After complete work, Inform Neom Ops Proponent or Representative

Permit to Work Clearance: Each permit is for specific location, time frame and task.
Permit Holder is responsible for leaving the work area clean and tidy and removing locks and personal dander tags used for the equipment isolation.
Once work has been complete or Permit to Work expires, permit must be closed out and report to the FM Health and Safety auditor.
If the Job is incomplete, details of work to be carried over to next day are to be noted in space provided above of original by Permit Holder.
Any incident, unexpected occurrence or deviation from regular work practices will be noted and discussed with the workers doing this work and their supervisors.