Extended / Night Work Request Form

RSG-HS-FRM-0065

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General Information
25-Mar- 25-Mar-
Program/Facility Date From To
24 24

Project Name Builder works Package for Rosewood at Amaala Triple Bay Central

Contractor Abdul Mohsin Al Tamimi Total Manpower 294

Location Zone 1,2,3,4,HOH Working Hours 1 Hours (1PM-2PM)

Job Description
-Scaffolding Erection & Dismantling works in HOH & Zone 2,1.

2-Scaffolding material shifting in HOH & zone 2,1.3.

3-Leftover Block Removal & Housekeeping in Zone 1,2,3,4,HOH.

4- Plaster Work in Zone 1,2,4,HOH.

5 Painting work in zone 1,2,3,4,HOH.

6-Finishing work block installation zone 2,3,1.

7-Surface finishing wall chasing work.

Justification
To catch up the program and to removed / reduce the quantity of waste at site☒

Mandatory Attachments

☒ Employee List ☐ Night Work Checklist ☒ Method Statement ☒ Risk Assessment ☒ Emergency Response Plan

Contractor Declaration
Duty Murad , Abdullah Tel. / Mobile
Supervisor Alsayar, ,Elavarsan,Nageh,Yousif,Fazal,Issa,Badar. No.0552480857/0570939191
/
Tel. / Mobile No.
Duty HS 0582412970/0551941179
Nisar/Ayaz/Amit/Ashfaq/Waseem/Hazrat/Muhammad
Officer /0538789356/0569349326
0597765072/0565838959

25-Mar-24

RSG-HS-FRM-0065
Rev. 00, 30 Apr 2023 Page 1 of 3
 Ahmed EL Saeed

Construction Manager Signature Date

Eleumar Carmona 25-Mar-24

HS Manager Signature Date

Ahmad Atef 25-Mar-24

Project Manager Signature Date

IMPORTANT: By signature hereon. Contractor/Sub-Contractor hereby confirms that extended work / night work is being applied for and conduced within the
Saudi legislated allowable working hours/week. This will be continually monitored by Contractor/sub-Contractor Site Manager, who is responsible for ensuring
compliance with The Saudi Laws & Night Work Control Procedure.

Consultant Supervision attendance that are required for outside normal working hours which is being requested through this form, will be charged to the
Contractor at the rate as/where applicable under the Contract,

RSG-HS-FRM-0065
Rev. 00, 30 Apr 2023 Page 2 of 3
Extended / Night Work Request Form
RSG-HS-FRM-0065
Supervision Attendance Requirements (to be populated by Supervision Consultant)
Inspection Required
☐ Mandatory Hold Point ☐ Monitoring ☐ Witness Point ☐ NIL
Additional Attendance
SL No. Category / Designation Number of Consultant required Remarks

Note: Actual time sheet (template attached) shall be maintained and signed by both parties. Supervision Consultant shall distribute the duly signed timesheet
upon completion of the requested out of hours/ extended hours services as trailing Mail to this request in the Aconex.

Supervision Consultants / FM Operator Declaration

Recommended By

44
Date
Resident Engineer /
Signature Date
FM Supervisor

IMPORTANT: Supervision Consultant /FM operator acknowledges that supervision attendance identified in this form is adequate for the Contractor’s requested
Works and will be responsible to obtain, maintain and circulate the duly signed attendance sheets and produce for any commercial entitlement.

Comments

-Tamimi to ensure emergency services such as ambulance and nurse full time.

- Tamimi to ensure full time supervision both safety and construction

RSG Review and Approval

Reviewed By

Date
Project/facility Signature Date
H&S Representative

Approved By

Date
Senior Construction Manager Signature Date
/ Facility Manager

Comments

RSG-HS-FRM-0065
Rev. 00, 30 Apr 2023 Page 3 of 3