IRAQ GENERAL COMPANY - MOD PROJECT IRAQ GENERAL COMPANY - MOD PROJECT

COLD WORK PERMIT - MAXIMUM 7 DAYS FROM START (REQUESTING 24H BEFORE)

SITE MOD PERMIT NO PERMIT REF. 7. PERMIT DAILY VALIDATION (PERFORMING AUTHORITY,AFFECTED AREA AUTHORITY, HSE REPRESENTATIVE , & AREA AUTHORITY)

LOCATION WTP ZONE CONTROL SEPTIC TANK START DATE 12.08.2023 I HAVE CHECKED ALL THE ATTACHED DOCUMENT THE WORK CAN BE START WITH CONTINUE INSPECTION IN SITE. ‫ﻟﻘﺪ ﺗﺤﻘﻘﺖ ﻣﻦ ﺟﻤﻴﻊ اﻟﻤﺴ�ﻨﺪات اﻟﻤ ﺮﻓﻘﺔ و�ﻤﻜﻦ �ﺪء اﻟﻌﻤﻞ ﻣﻊ اﺳﺘﻤ ﺮار اﻟﻔﺤﺺ �� اﻟﻤﻮﻗﻊ‬.
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COMPANY NAME ALEIMARA ALIRAQIAH EXPIRY DATE 18.08.2023 DATE
DAYS PA AAA HSER AA REMARKS CLOSE TIME
1. PERMIT REQUEST (PA) - PERFORMING AUTHORITY ‫اﻟﺴﻠﻄﺔ اﻟﻤﻨﻔﺬة ﻟﻠﻌﻤﻞ‬ TIME

WORK DESCRIPTION: FORM WORKS AND REBAR WORKS FOR SEPTIC TANK ROOF
DAY 1

DAY 2

DAILY VALIDATION
TOOLS & EQUIPMENT TO BE USE: POWER AND HAND TOOLS
DAY 3

2. WORK CONTROL & DOCUMENTATION (PA) - PERFORMING AUTHORITY ‫اﻟﺴﻠﻄﺔ اﻟﻤﻨﻔﺬة ﻟﻠﻌﻤﻞ‬
DAY 4
ATTACHMENTS REQUIRED ✓ DOC NO.(if any) CERTIFICATES REQUIRED ✓ DOC NO.
TBT ✓ RADIOGRAPHY CERTIFICATE
METHOD STATEMENT ✓ 3054 MECHANICAL ISOLATION CERTIFICATE DAY 5
RISK ASSESSMENT ✓ 177 GAS TEST CERTIFICATE
PA

LIFTING PLAN CONFINED SPACE CERTIFICATE ✓

DAY 6
DRAWINGS EXCAVATION CERTIFICATE
INSPECTION CHECKLISTS ELECTRICAL ISOLATION CERTIFICATES
MSDS 3rd PARTY CERTIFICATES DAY 7
EMERGENCY CONTACTS LIST/FLOWCHART SCAFFOLDING CERTIFICATE
OTHER:
8. SUSPENTION & RE-ISSUE
3. HAZARDS IDENTIFICATION (PA) - PERFORMING AUTHORITY ‫اﻟﺴﻠﻄﺔ اﻟﻤﻨﻔﺬة ﻟﻠﻌﻤﻞ‬
CORROSSIVE
✓ PHYSICAL HAZARDS ELECTRICAL HAZARDS NOISY AREA (85db) FLYING PARTICLES REASON OF SUSPENSION:
MATERIALS
CHEMICAL HAZARDS WORK AT HEIGHT LIFTING OPERATIONS EXCAVATIONS/TRENCHING ✓ CONFIED SPACES PERMIT SUSPENDED BY
RADIOACTIVITY ✓ MANUAL HANDLING MECHANICAL HAZARDS ✓ HEAT/COLD STRESS WIND, WEATHER STATUS DATE TIME NAME POSITION SIGNATURE

SUSPENTION & RE-ISSUE

OTHERS:
I UNDERSTAND THE WORK CONTROLS & HAZARDS IDENTIFICATION OF SPECIFIED ON THIS PERMIT (AND REFERENCES ATTACHED) AND ACCEPT RESPONSIBILITY FOR CARRYING OUT THE WORK AS DETAILED ‫أﻓﻬﻢ ﺿﻮا�ﻂ اﻟﻌﻤﻞ‬ DUE TO OPERATION & SAFETY REQUIREMENTS, THIS PTW HAS BEEN SUSPENDED AND WILL REMIND INACTIVE UNTIL FURTHER NOTICE. ‫ ﻓﻘﺪ ﺗﻢ ﺗﻌﻠﻴﻖ ﺗ ��ـ ــﺢ اﻟﻌﻤﻞ ﻫﺬا وﺳ�ﻈﻞ‬، ‫ﻧﻈ �ﺮا ﻟﻤﺘﻄﻠ�ﺎت اﻟ�ﺸﻐ�ﻞ واﻟﺴﻼﻣﺔ‬
‫وﺗﺤﺪ�ﺪ اﻟﻤﺨﺎﻃﺮ اﻟﻤﺤﺪدة �� ﻫﺬا اﻟﺘ ��ـ ــﺢ )واﻟﻤ ﺮاﺟﻊ اﻟﻤ ﺮﻓﻘﺔ( وأﻗ�ﻞ اﻟﻤﺴﺆوﻟ�ﺔ ﻋﻦ ﺗﻨﻔ�ﺬ اﻟﻌﻤﻞ ﻋ� اﻟﻨﺤﻮ اﻟﻤﻔﺼﻞ‬ ‫ﺣ� إﺷﻌﺎر آﺧﺮ‬ � .
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DATE TIME NAME (PA) SIGNATURE (PA)
NORMAL OPERATION HAVE BEEN RESUMED. ‫ﺗﻢ اﺳ�ﺌﻨﺎف اﻟﻌﻤﻠ�ﺔ اﻟﻌﺎد�ﺔ‬.
11.08.2023 13:00 WALEED THE WORKSITE HAS BEEN INSPECTED AND CONTROLS AND PRECAUTIONS FOUND IMPLEMENTED IN PLACE. ‫ﺗﻢ ﻓﺤﺺ ﻣﻮﻗﻊ اﻟﻌﻤﻞ وﺗﻢ وﺿﻊ اﻟﻀﻮا�ﻂ واﻻﺣﺘ�ﺎﻃﺎت ﻣﻮﺿﻊ اﻟﺘﻨﻔ�ﺬ‬
THIS PTW MAY NOW BE RE-ISSUED. ‫ﻗﺪ ﻳﺘﻢ إﻋﺎدة إﺻﺪار ﻫﺬا اﻟﺘ ��ـ ــﺢ اﻵن‬.
4. REQUIREMENT FOR SAFE WORKING CONDITIONS (AAA) - AREA AFFECTED AUTHORITY ‫ﺳﻠﻄﺔ اﻟﻤﻨﻄﻘﺔ اﻟﻔﻌﺎﻟﺔ‬
SHUT DOWN CHECK MSDS GAS CHECKS PRIOR STARTING CONTINUITY BONDING / EARTHING REQUIRED WARNING NOTICE DATE NAME POSITION SIGNATURE
TIME
REQUIREMENTS
FALL PREVENTION SHIELDING/SHORING SAFETY SYSTEM (S) BYPASSED / LOTO VENTILATE PROPERLY
INHIBITED
OTHER :
AAA

9. PERMIT CLOSED (PA,PC & AA)

I CONFIRM THAT I AM AWARE OF THE WORK AS SPECIFIED ON THIS PERMIT AND IT MAY PROCEED. ‫أﻧ� ﻋ� د را�ﺔ �ﺎﻟﻌﻤﻞ اﻟﻤﺤﺪد �� ﻫﺬا اﻟﺘ ��ـ ــﺢ وأﻧﻪ ﻗﺪ ﻳﺘﻢ إﺟ ﺮاؤە‬
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DATE TIME NAME (AAA) SIGNATURE (AAA) DATE: TIME: PERFORMIG AUTHORITY(PA) NAME: SIGNATURE:

DATE: TIME: PERMIT COORDINATOR(PC) NAME: SIGNATURE:

5. HSE REQUIREMENTS FOR IMPLEMENTATION BY PERFORMING AUTHORITY ‫ﻣﺘﻄﻠ�ﺎت اﻟﺼﺤﺔ واﻟﺴﻼﻣﺔ واﻟﺒ�ﺌﺔ ﻟﻴﺘﻢ ﺗﻨﻔ�ﺬﻫﺎ ﻣﻦ ﻗ�ﻞ اﻟﺴﻠﻄﺔ اﻟﻤﻨﻔﺬة ﻟﻠﻌﻤﻞ‬ DATE: TIME: AREA AUTHORITY(AA) NAME: SIGNATURE:
GOOGLES / FACE SHIELD SCBA TO BE WORN SAFE ISOLATION REQUIRED COVERALL CLOTHING ACCESS /ESCAPE ROUTE CLEARED / PROVIDED 10. PERMIT CONTINUATION (PA,PC & AA)
EAR MUFFS/PLUGS DUST MASK TOOL BOX TALK REQUIRED BASIC PPE VENTILATE PROPERLY THE WORK IS TO CONTINUE UNDER NEW PTW:
HAND PROTECTION CLOSE MONITORING SAFETY HARNESS / LIFE LINE RADIO CONTACT REQUIRED BARRIERS & WARNING SIGNS

PERMIT CONTINUATION
HSER

POSITION NAME SIGNATURE DATE TIME

WELFARE FACILITIES OTHER:

DATE TIME NAME (HSE REPRESENTATIVE) HSER SIGNATURE (HSER) PERFORMING AUTHORITY(PA)

PERMIT COORDINATOR(PC)

6-ISSUANCE (AA) - AREA AUTHORITY - ‫ﺳﻠﻄﺔ اﻟﻤﻨﻄﻘﺔ‬ AREA AUTHORITY(AA)

I CONFIRM THE DOCUMENT COMPLETE; THE SITE HAS BEEN CHECKED, THE PRECAUTIONS SPECIFIED ON THIS PERMIT ARE SUFFICIENT FOR THE PROPOSED WORK, THE NECESSARY CONTROLS ARE IN PLACE AND WORK MAY
THIS PERMIT IS NOW CLOSED. PERMIT REGISTER TO BE UPDATED
PROCEED. ‫ واﻟﻀﻮا�ﻂ اﻟﻼ زﻣﺔ ﻣﻮﺟﻮدة وﻗﺪ ﻳﺘﻢ اﻟﻌﻤﻞ‬، ‫ واﻻﺣﺘ�ﺎﻃﺎت اﻟﻤﺤﺪدة �� ﻫﺬا اﻟﺘ ��ـ ــﺢ �ﺎﻓ�ﺔ ﻟﻠﻌﻤﻞ اﻟﻤﻘ �ح‬، ‫أﻧﺎ أ ؤﻛﺪ أن اﻟﻮﺛ�ﻘﺔ ﻣﻜﺘﻤﻠﺔ ؛ ﺗﻢ اﻟﺘﺤﻘﻖ ﻣﻦ اﻟﻤﻮﻗﻊ‬
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AA

DATE TIME NAME (AA)

SIGNATUER (AA)
DISTRIBUTION: ORIGINAL - AT WORK SITE WITH PA, COPY 1 HELD IN HSE OFFICE