NATIONAL WATER COMPANY

Permit To Work
(PTW)
Project Name: ‫انشاء منظومة اعادة استخدام مياه الصرف الصحي المعالجة بمدينة بريدة‬
Project No.: 04/18/2/48/0169/1
Contractor Company Name: MUTLAQ AL-GHOWAIRI CONTRACTING CO. (MGC)
Supervision Consultant Company Name: SAUDI CONSOLIDATED ENGINEERING COMPANY
Method Statement Title:
Method Statement Document Reference:
Method Statement Version:
Method Statement Date:
Requested Start Date: 02/07/2022
Requested Finish Date: 21/07/2022
AUTHORIZATION AND ACKNOWLEDGEMENT
Signatures of authorized persons are required in order to activate this Permit-To-Work:
Authorized by: Supervision Consultant Acknowledged by: Contractor
Start Date (DD/MM/YYY): 02/07/2022 End Date (DD/MM/YYY): 21/07/2022
Safety Safety
ENG. ABDULLAH GHANNAM ………………… ENG. ABDUL RAFEEQUE …………………
Manager Manager
Project
Site Manager ENG. MUHAMMED ZAKI ………………… ENG. SA’AD SHEHBANI …………………
Manager
VALIDITY
The Permit-To-Work is valid for defined activity only, based upon an initial activation period. It may be revalidated for further
activation periods (e.g., for change of shift), provided the relevant authorization and acknowledgement signatures are
obtained prior to each revalidation.
Heat Stress works (cutting & Welding )‫التعرض لدرجات الحرارة العالية (قطع للحام‬
Isolation Lockout and Tag-out ‫العزل الميكانيكي والكهربائي‬
Confined space entry ‫العمل داخل األماكن المغلقة‬
Activity covered by Excavation / Trench ‫ خندق‬/ ‫عمل حفرية‬
this permit: Hazardous Chemical Materials‫التعامل مع مواد كيمائية خطرة‬
Work at height ‫العمل على ارتفاعات‬
Dealing with Asbestos ‫العمل تحت نطاق اإلسبيستوس‬
Lifting Operation and Equipment ‫معدات وعمليات الرفع‬
Other (If ‘other’, describe the activity below)

QUALITY
DESCRIPTION:
1. Plastering work at Pump Station
Approved Submittals/Document Approval Status
Submittals/Documents
No. ‫حالة االعتماد‬
‫الوثائق‬/‫التقديمات‬
‫الوثائق‬/‫الرقم المرجعي للتقديمات‬ Yes No
Shop Drawings      
MAT submittal      
Method Statement      
ITP      
Amanah PTW      
Traffic PTW      
others        
Activation Perio Operator Name Consultan Operator Name Consultan
period(s): d (1) t initial t initial
Perio
From
Contracto d (2) Contracto
6.00........hrs
r initial r initial
To.... 17.00....hrs
CLOSURE / CANCELLATION
Name Signature Date

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 Supervision Consultant

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