Work Permit Training Request Form

Document Number HSE-OHSMS-SOP6-F01 Revision Number 03

TO: HSE Department

King Abdullah University of Science & Technology

RE: Work Permit Process Training Request

New or Retraining
Card Type Requested Certification
Name of Employee
KAUST ID (Please Specify)
Company Trade
No. or /Iqama Area
( as written in the KAUST ID or/ Iqama Name Skill/Position Title
No.
)

Electrical Work
Work At Height

Space Entry
Work Permit

High Pressure

Road Closure
Operations
Excavation
Receiver

Hot Work

Confined
Process
Issuer

Lifting
Systems
Work
GDH
1 Mohamed Elshokrofy 166014 ABC Data Engineer
Center

GDH
2 Biju C. Babu 143996 ABC Data Supervisor
Center

GDH
3 Muhammad Niaz 169562 ABC Data Supervisor
Center

Please confirm that all nominees for training meet the following requirements: (Tick the box)
1) He/she has the ability to apply knowledge and skills to achieve intended results.
2) They have a basic understanding of the work permit procedure.

Work Permit Training Request Form

 Work Permit Training Request Form

Document Number HSE-OHSMS-SOP6-F01 Revision Number 03

3) Is proficient in English (written and verbal).

4) Has work knowledge of hazards associated with the work to be carried out.
5) Is deemed capable of conducting the responsibilities of an Issuer or Receiver safely.

Requested by: Email Address: Contact No:

___________________________________ _______________________ ___________________

Unit/Area/Department/Project Manager
(Service Provider/Contractor)

___________________________________ _______________________ ___________________

HSE Manager/Engineer
(Service Provider/Contractor)

Approved by:

___________________________________ _______________________ __________________

KAUST Proponent

Note:
 Please ensure that all information (Name and ID or / Iqama number) is correct as written in the KAUST ID or Iqama.
 Submit completed page and signed form to KAUST HSE Department by email: workpermit.hse@kaust.edu.sa

Work Permit Training Request Form