ADNOC Classification: Internal

Night Journey Approval Form

Project Title: Contractor:

H5 Debottlenecking for Associated Gas PX Division
Location: Habshan-5 Month: April 2023
Driver Name: Vehicle No. Justification (Work Related)
Jefferson Mercurio 58359 Attended employers function during
Ramadan held in Abu Dhabi City

Requestor:
12-Apr-2023
Jefferson Mercurio
Name: ______________
PX HSE
Position / Department: ________________
______________________
0563086343
Contact details: _________________ Name / Signature / Date

To assess the night journey risks, the following should be addressed:

Description Yes No Remarks
Can the journey be deferred?
Is there impact if the journey is deferred (people /
environment / asset / reputation)? If yes, specify in the
remark’s column
Does the journey require off road travelling?
Is there a previous (already prepared) risk assessment
for the required journey / activity?
Is the journey route identified?
Is the journey route found to be safe for travel?

Journey is approved ☐ Journey is not approved ☐

_________________________ ____________ ________

Requestor Manager’s Approval Signature Date

Note: If the journey is approved, ensure that the night journey control measures
(checklist attached) are implemented prior to the journey.

Distribution: Original to be returned to requesting party

Copy to be retained by ADNOC GAS PX Road Safety Coordinator

Mr. Sibtain Zia szia@adnoc.ae 0503049974

ADNOC Classification: Internal
Night Journey Approval Form

NIGHT JOURNEY CONTROL MEASURES CHECKLIST

No Checklist Item Description (write N/A if not applicable) (√)

1 ESTABLISH the actual requirement to drive i.e., is this journey required or it
can be postponed till next day morning?
If required: tick (√) and if it can be postponed: tick (X) and don’t allow the
journey to take place

2 HAVE all safety control measures been considered / implemented:

• Driver had enough rest
• Communication means are provided and functionally tested
• Vehicle is suitable for the terrain
• Vehicle is equipped with desert kit if applicable
• Vehicle is equipped with flood lights if required
• Vehicle is equipped with spark arrestor (if required)
• Vehicle Has ROP’s if applicable

3 ENSURE selected drivers are familiar with the road and locations

4 CONSIDER reducing the maximum allowable speed limit to suit local

conditions

5 EMPHASISE that the journey should be conducted on approved established

roads where possible

6 Ensure that no deviation from the planned road will take place.