DNSTW PROJECT, QATAR

GENERAL PERMIT-TO-WORK
GENERAL
Date of Work Start:
Date of Work End:
Permit sanctioning exclusively between 08.00 hrs and 10.00 hrs each Working Day in T&C Permit Office
NOTES

Permit No.

Type Addenda

Addenda Attached *Yes / No

* Tick off box

Permit requests to be handed-in 24 hrs in advance of effectuation to Permit Coordinator

Approved original PTW's shall be kept in T&C Permit Coordinator file.
Any PTW is only valid for One Work Location from 0600 to 1800 hrs daily
Any work to be carried out after 1800 hrs shall be applied through PTW Coordinator before 1700 hrs daily (Out of hour notification)
Violation of PTW conditions shall make validity NULL-AND-VOID
,

Confined Space
Hazardous Substances
Hotwork
Lifting

*
*
*
*

PART A
Area

*
*
*
*

Work at Height
Excavations
Mechanical/Piping Systems; Isolations/Tests
Electrical Isolations/Energizations

APPLICATION

Nos of Docs attached; ** Tick off box

Building Name:

Work Location

Description of Work

Company

Supervisor in Charge
Nos of persons involved
Attachments
Plan view with location, boundary/barrier limits/escape routes
Lay-outs, drawings, P&ID's, D&ID's, Single Line Diagrams, Block Diagrams, Vendor instructions, Other
Work Area/Equipment Room clean and fully functional (lighting, HVAC, fifi systems, communication)
Check Lists
Job Safety Analysis
Lock-out/Tag-out Information
Remarks:

Date / Time

Mobile Phone
Work Classification
**
**
**
**
**
**

E&I
MECH
ARCH
T&C
OTHERS

I have prepared the undertaking of the tasks relevant to this PTW application and satisfied that with the information provided and precautions taken this work can be safely conducted.

Name / Signature Applicant

Date / Time
I have verified this PTW application and satisfied that with the information provided an precautions taken this work can be safely conducted

Mobile Phone

Name / Signature Sub-Contractor Safety Officer

Date / Time

Mobile Phone

Date / Time

Mobile Phone

Name / Signature Area Manager or Engineer in Charge

PART B

VALIDATION

I have examined the work location for safety, cleanliness and readiness to undertake the applied permit tasks and satisfied that with the efficient lockout/tag-out precautions taken as detailed in attachments, the tasks can be performed safely and efficiently.
Name / Signature T&C DEE / DME in Charge

PART C

Date / Time

Mobile Phone

ACCEPTANCE /EFFECTUATION

I have examined the work location, did meet and discuss Permit conditions including job risk assessment and safe control of work location with Applicant, also Foreman in Charge and declare that
work can be safely conducted
Name / Signature KSES Safety Officer in Charge
I viewed PTW with attachments and endorse signed above, therefore this PTW now in effect

Date / Time

Mobile Phone

Name / Signature T&C Manager or delegate

Date / Time

Mobile Phone

PART D

Cancellation

I have examined the work site and found left in clean and safe condition with re-instatements / de-isolations saisfactorily completed. This Permit is Requested by
hereby formally cancelled.
Name/Signature/Date/Time Applicant
Name / Signature T&C DEE / DME in Charge
Date/Time
Confirmed by
Name / Signature KSES Safety Officer

Date/Time

Name/Signature/Date/Time (KSES)

Distribution of Permits

Original to Safety Department (Permit Office)

Duplicate to applicant

DME denotes Dedicated Mechanical Engineer

DDE denotes Dedicated Electrical Engineer

Denotation

E&I-Electrical, Instrument & Telecommunication Services

MECH-Mechanical Equipment & Services
ARCH-Architectural Works
T&C-Testing & Commissioning
OTHERS- Any works other than the abovementioned

PTW Valid Weekly from 0600hrs to 1800hrs daily

KSES/EHS/028