2024 -1023

Health Safety Environmental Management System

HSE Permit

Applicant (Pink)/ Security (Green)/ Endorsee (White)

Requester Portfolio Commercial Residential Retail
Height work Mechanical Lifting Hot work
Type of Activity Confined space Spray painting Use of Dangerous goods Demolition
Events (including film shooting) Services Isolation Excavation Others
Valid from Valid to Permit Status
Permit Validity New Extension
23.02.2024 09:00 AM 23.03.2024 09:00 PM
Entity/Mall/Community Blue waters Job location/Unit/Site SJ 003

Stage 1: Applicant (Application by Service Provider / Business Partner /Contractor)

Contractor/ Service Provider Name No. of persons
ROYAL AMBIANCE BUILDING CONTRACTING LLC involved in Task/
10
Business Partner /Tenant Name Ac vity
RANGE SPACE GYM LLC
Brief description of the task / activity: This permit does not include any hot work activities
Valid permits must be displayed at the site
Installation of Signage Mockup only
Scaffolding must be inspected and erected by trained and competent personnel only
Measures Yes No N/A
1. Ac vity based Risk Assessment / task procedure attached
2. Ac vity based Method Statement / task procedure attached
3. Test cer ficates, approvals, licences, checklists, etc. relevant to the task/ac vity are attached
4. Isola�on of MEP /Fire system required and / or restricted area / me
I claim full responsibility of any unsafe act/condition, property damage and accident due to the activity
Name Designation Date
Kamil Manzoor project manager 23.02.2024
Signature Contact No. Time
0522348422 1:00 PM

Stage 2: Endorsee (By Facilities Management / HSE)

Remarks: The permit has been issued on the request of the Applicant. Issuance of this permit does not relieve the applicant
from any of legal and/or contractual obligations. This permit shall immediately become invalid in the event of any incident
and/or emergency at the work site. Applicant shall at all times adhere to all safety measures prescribed by law and/or the
endorsee in respect of the works undertaken at the work site.

Name Esther Ndungu Designation HSE Date 23.02.2024

Signature Contact No. Time
Stage 3: Entry pass (Issued by site security)
No. of passes issued Pass details:

Name Ahmed Alarj Designation Date

Signature Contact No. Time

Stage 4: Work completed / stopped (Security / Facility Management / HSE)
Brief descrip on of work completed / stoppage:

Name Designation Date

Signature Contact No. Time

Classification: Internal

Health Safety Environmental Management System

HSE Permit
Definition and Requirements for HSE Permits:
1. The applicant is fully liable to comply with all applicable legal requirements and is responsible for any injury / illness to personnel,
penalties, property damages, and interruptions. The works can be resumed only after settling such issues to the satisfaction of
DHAM / Authorities.
2. The work shall not commence until the permit has been duly completed and signed by the respective personnel.
3. The completed permit (applicant copy) shall be displayed in the vicinity of the task / activity.
4. The applicant/contractor/tenant is responsible to report all incidents and emergencies to DHAM and relevant authorities
5. The applicant/contractor/tenant is responsible to investigate all incidents and provide reports to DHAM and relevant authorities
6. The applicant/contractor/tenant is responsible to reinstate the damages caused by the activity to the satisfaction of DHAM /
authorities.
7. It shall be the duty of the Applicant to maintain safety requirements throughout the job performance.
8. The permit shall be invalidated if conditions change or if any incompatible work processes need to be carried out due to priority
and/or safety/other violations. During these situations, the applicant shall notify Security and Endorsee.
9. If the job is not completed within the stipulated time, a fresh permit shall have to be raised and the copy of the permit marked
“Applicant” shall be handed over to the endorsee.
10. The Applicant shall inform the Security and Endorsee once the job has been completed. If the copy marked “Applicant” is not
returned to the endorsee, it shall be assumed the job has not been completed and other incompatible work processes shall not be
approved.
11. It is the responsibility of the Applicant to remove the display copy once the job has been completed or when the permit has expired.
12. Copy of NOCs and Valid permit must be available in the vicinity of the job for verification during inspections.
13. The renewal of the permit after its expiry is subject to the evaluation of the work status by the endorsee.
14. Common areas including elevators shall be protected against damages during mobilization, transportation of materials and
execution of works
15. Fire detection and protection system including smoke detectors shall be protected during the course of work.
16. Work premises and common areas shall be kept free of dust and garbage.
Height work
17. Outdoor height work shall be suspended during inclement weather such as rain, storm and/or if wind speed is above 18mph or 16
knots.
18. Full body safety harness shall be worn, and the lifeline anchored to a safe anchoring point throughout the work activity.
19. Activities with Scaffolding: This permit is valid only with “Scaffold Completion Certificate” endorsed by a competent person.
Hot work
20. HSE Permit for hot work is invalidated should combustible substances be introduced in way of the hot work area or should any
incompatible work be carried out in the same area.
21. Maximum validity of permit to work in HOT work should be 24hrs and applicant is responsible to renew the permit. This is
subject to the criticality of hot work being carried out.
22. Hot work activities to be undertaken by a trained, certified and competent personnel only.
23. A trained and certified fire watcher and a functional fire extinguisher must be present at the site.

Use of hazardous material

24. Copies of the material safety data sheet (MSDS) of the chemicals to be used shall be submitted together with the permit application
to the endorsee by the applicant/contractor/tenant.
25. Any change in chemicals other than those stated in the permit application shall render the permit invalid. The
applicant/contractor/tenant shall submit a fresh permit application if he intends using chemicals not mentioned in the permit.
26. No hot work shall be carried out in the vicinity of spray painting with flammable material.
Confined Space
27. Maximum validity of permit to work in confined space should be 24hrs and applicant is responsible to renew the permit.
28. Applicant is responsible to measure the air quality inside the confined space and provide declaration of the measurement.
29. The persons entering a confined space shall: -
x Deploy one person (sentry) outside the confined space throughout the activity.
x Prior to entry, check whether the entry permit is valid and carries the appropriate endorsement by Applicant.
x Personnel entering ventilation ducts, service shafts and sewage manholes shall wear full body harness and lifeline shall be
anchored outside the ducting.
x Respiratory protection is mandatory for personnel entering sewage systems.
Demolition
30. Maximum validity of permit to work in confined space should be 24hrs and applicant is responsible to renew the permit
31. Only skilled /trained workers shall perform the demolition activity.

Mechanical Lifting
32. Plants, Machinery, Equipment shall possess valid licenses and third-party inspection certificates as applicable.
33. Ensure Load and lifting attachments are secured
34. Pads are placed where wire ropes has to bend around sharp edges.
35. Properly trained signallers are assigned to the lifting operation.
36. Workers to ensure the path of travel and the ground conditions are stable and level prior to start of work and are aware of safe
system of work.
37. Barricades and proper safety signage to be put in place