DocuSign Envelope ID: 270C2D41-E3E0-43FF-9026-8FF86A3AB2E0

Qatargas EPC-3 NFXP Onshore

Extended Hours (FRIDAY & HOLIDAYS / NIGHTSHIFT) OVER TIME WORK REQUEST
Details to be checked by TR Discipline Lead / Manager prior to submission for approval
DATE: 08/02/2024-07/03/2024
REQUESTED BY (Print Name): Krishna Kumar Nallu samy TELEPHONE No.: 66705490 Rev.1

Verified at Site
1. SUBCONTRACTOR NAME: Mandatory Requirements In Place Not in place
Signature or N/A
China Eleventh Chemical Construction Company (ELECO) Valid Permit YES

Adequate Lighting (night time / hours of darkness) YES

2. LOCATION:
Lean Gas Non-Crossing non crossing area(T2 ) Flashing lights (night time/ hours of darkness) YES
Lighting torch (night time/ hours of darkness) YES
Suitable & Sufficient PPE YES
SHES Training YES
3. NATURE OF WORK: Scaffold / MEWP N/A

SHIFT (DAY / NIGHT) TIME (24 HRS. FORMAT) Suitable and sufficient access & egress YES
NIGHT 18:00 Hrs to 006:00 Hrs. Access for emergency vehicles YES

PERMIT NUMBER (additional sheet if TOTAL NOS. OF Signs/ barricades specific to work YES
S.N. NATURE OF WORK:
required) WORKERS Road diversion - signs/ notifications YES
1 WELDING 123911 16 Supervisor & SHES with contact numbers YES

2 NDT Activity 122262 5 Supervision at all times YES

Fire Equipment/ Fire Watch YES

Housekeeping YES

Method Statement & JSA YES

Lifting Plan YES

Task Instruction, TBT, LMRA YES
TOTAL 21 Standby Electrician YES
Others: specify
4. SUBCONTRACTOR SUPERVISION
S.N. LINE SUPERVISOR (1:20) AREA/ACTIVITY TELEPHONE NO.
1 Juno Lean Gas Non-Crossing area(T2 ) 70766101
2 GOPALA KRISHNAN (NDT) Lean Gas Non-Crossing area(T2 ) 7124 6917
3
S.N. FOREMAN/CHARGEHAND (1:10) AREA/ACTIVITY TELEPHONE NO.
1 ADDITIONAL INFORMATION IF NEED:

S.N. SHES SUPERVISOR (1:200) AREA/ACTIVITY TELEPHONE NO.

1 TONY CHACKO Lean Gas Non-Crossing area(T2 ) 77969659
2 SELVIN Lean Gas Non-Crossing area(T2 ) 7716 0733
3 ADNAN ILAHI Lean Gas Non-Crossing area(T2 ) 7129 5651
S.N. SHES OFFICER (1:50) AREA/ACTIVITY TELEPHONE NO.
1
2
3

5. TR SUPERVISION
S.N. LINE SUPERVISOR AREA/ACTIVITY TELEPHONE NO.
1 KHALID FODIL Lean Gas Non-Crossing area(T2 ) 3368 9196
2 PIUS SHERMI Lean Gas Non-Crossing area(T2 ) 5113 1566
3 Sanjay Lean Gas Non-Crossing area(T2 ) 20726250
S.N. SHES SUPERVISOR AREA/ACTIVITY TELEPHONE NO.
1 Sreejith Narayana Thottathil Sivan Lean Gas Non-Crossing area(T2 ) 33680652
2 Leandro JR Panopio Marquez Lean Gas Non-Crossing area(T2 ) 66806183

6. INCIDENT REPORTING
S.N. Name AREA/ACTIVITY TELEPHONE NO.
1 JOC Lean Gas Non-Crossing area(T2 ) 44745888
2 JOC operator Anjum Nawaz Lean Gas Non-Crossing area(T2 ) 8008808
3 JOC operator Muhamed haroon jan Lean Gas Non-Crossing area(T2 ) 8008808
4 Security Patroling Sup Slimane Bin Ahmeed Abid Lean Gas Non-Crossing area(T2 ) 33467573

7. PROVISION FOR EMERGENCY TRANSPORTATION

S.N. Name AREA/ACTIVITY TELEPHONE NO.

Approved by:

Gousuddin Mohammed Paul Meihon

CONTRACTOR Site SHES Manager COMPANY SHES Division Manager
(Print Name and Signature) (Print Name & Signature)

Krishnakumar Nallusamy Christopher Lawrence Calvert

CONTRACTOR construction Manager COMPANY Construction Division Manager
(Print Name & Signature) (Print Name & Signature)

ALL ENTRIES MUST BE CLEAR AND LEGIBLE

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