WORK PERMIT (General)

Shoaiba RO Ph.4 Desalination Plant Project Permit No. DHI-SRO4-EHS___

Section Ⅰ. General Information
Company : Wardah Al Susan Manpower : Date : 19 / 09 / 2019 . ~ 24 / 09 / 2019 .
Period
Specific Location : Emergency Pond Time : 6 : 00 AM ~ 7 : 00 PM

Responsible person : Mizanur Rahman Contact No.(Mobile) : +966 572927530

Class of Work □ Holiday Work □ Night Work

[ ] Hot Work [ ] Confined Space Work [ ] Excavation (more than 1.2 m) [ ] Critical Lifting [ ] Scaffolding (4m↑)
[ ] Hazardous Work : □ Radiography □ Chemical handling □ Other hazardous work
■ Cold Work : □ Working at height more than 2m □ Moving and Lifting heavy material less than 10 ton □ Roofing & Siding
□ Install / Dismantle temporary structure(Less than 4 m supporting, scaffolding, etc.) □ Install machine or frame
nderwater □ Working above or near water □ Working nearby high voltage □ Others:
★ Removal of : □ Safety net, □ Grating, □ Handrail, □ life line, □ Opening cover, □ Others
Equipment: (Excavator : 1 ), (Dump Truck : 2 ), (Boom Truck : ), (Mobile Crane : ), (Trailer : ), (E/M Eqpt.s : )
Work Description: Excavation and Back Filling around the Emergency Pond

Risk Type
R Fall □ Falling □ Caught in □ Struck R Slip □ Cutting □ Electrical Shock □ Burn □ Explosion
□ MSD □ Env. Contamination □ Others

Personal Protective Equipment (PPE) are suitably provided for working as item below :
R Safety Helmet R Safety Goggle R Safety Shoes □ Safety Harness □ Dust / Chemical Mask
□ Ear Plugs / Muff □ Respirator □ Face Shield □ Rubber / Leather Gloves □ Rubber Boots □ Others :

Documents Available:
R Risk Asessment R Method Statement □ Certificates □ Plan Drawings / Sketch with mark up

Risk Comments in Addition to Risks in R.A.:

Misoperation, Human Error, Entry of Non-Authorized Personals

Risk Improvement Method

1 . Providing Check-list for the operators.
2. TBT before the work commences.
3. Provide trainings and refreshment trainings.

Section Ⅱ. Application of Permit

Site Manager WARDAH AL SUSAN Name : Mosharaf Hussain Signature :

Section Ⅲ. Approval of Permit (DHI)

DOOSAN Construction Manager Name : S. H. Lee Signature :

Section IV. Verified By (DHI)

EHS Manager Name : C. S. Lee Signature : Time/Date :
Comments
Section V. Review
Date
Reviewer Position Remarks

Section VI. Cancellation

DHI Responsible Person Name : Signature : Time/Date :

Comments
Shoaiba RO Ph.4 Desalination Plant Project DS-EHS-FM-009