Lusail Real Estate Development Company

Health, Safety, Security, Environment, Logistics & Quality

Department

Lusail Construction Safety Procedural Form/Checklist – HSE Plan

Outline / Checklist

Document No: LUS-HSE-FM4-446-111.01 Rev: 1

Uncontrolled Copy Controlled Copy X Date: 1-Apr-15

COMPANY PROPRIETARY INFORMATION

Prior to use, ensure this document is the most recent revision by checking the Master Document List. To request a change, submit a Document
Change Request to the Document Control Representative. Master copy of this document will be maintained by the LREDC QA/QC Manager. Not
Controlled if printed.

Document No: LUS-HSE-FM4-446-111.01 Page 3 of 10

Change Request to the Document Control Representative. Master copy of this document will be maintained by the LREDC QA/QC Manager. Not
Controlled if printed.

Lusail Real Estate Development Company HSE Plan Outline/Checklist

Amendment Record
This document is reviewed to ensure its continuing relevance to the systems and process that it describes. A
record of contextual additions or omissions is given below:

Rev. No. Description / Comments Prepared By Checked By Approved By Issue Date

(Pg. 1) Company Propriety

1 Information - Not Controlled if HSE Working Group Michael Ford Uwe Krueger 1-Apr-15
printed has been added

1 (Pg. 2) Revised Amendment Table HSE Working Group Michael Ford Uwe Krueger 1-Apr-15

Document No: LUS-HSE-FM4-446-111.01 Page 4 of 10

Document No: LUS-HSE-FM4-446-111.01 Page 5 of 10
 Lusail HSE Plan Outline/Checklist

This checklist provides the minimum outline and requirements for all HSE Plans developed and submitted for approval for work on Lusail Development Projects.
Sections that are not applicable to a particular project scope shall be included, but with a cover sheet and statement "N/A-This section does not apply because..."

* Contractor to submit within 30 days after award of contract

* Contractor is not permitted to work on the worksite until such time as the plan has been approved by the Engineer

Project Name:

Contract Number:

Prime Contractor:

Reviewer Parsons/Lusail:

Section Yes No N/A Section Comments

1. Cover Sheet

Cover sheet provided

2. Signature Sheet - Title, signature,

and phone number of the following:

a. Plan preparer (Qualified Person,

Competent Person such as corporate
safety staff person, QC)

b. Plan approved by company/corporate

officers authorized to obligate company.

c. Plan concurrence (e.g., Chief of

Operations, Corporate Chief of Safety,
Corporate Industrial Hygienist, project
manager or superintendent, project
safety professional, project QC). Provide
concurrence of other applicable
corporate and project personnel
(Contractor).

3. Table of Contents

Table of Contents provided

4. Background Information list the

following:

a. Contractor/Contract #

b. Project Name

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c. Brief project description, Description
of work to be performed, and location;
Phases of work anticipated (these will
require a Risk Assessment).

5. Reference Documentation

Reference documentation provided

6. Statement of Safety and Health

Policy -

Provide a copy of current

corporate/company Safety and Health
Policy Statement, detailing commitment
to providing a safe and healthful
workplace for all employees. The
Contractor’s written safety program
goals, objectives, and accident
experience goals for this contract should
be provided.

7. Occupational Health & Safety

Objectives

Company HSE broad objectives

included in plan

8. Safety Organization &

Responsibilities

a. A statement of the employer’s

ultimate responsibility for the
implementation of his SOH program

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b. Identification and accountability of
personnel responsible for safety at both
corporate and project level.

c. Names and responsibilities of all

safety personnel deployed on & off the
worksite including night-time and
holiday working

d. Requirements that no work shall be

performed unless a designated
competent person is present on the job
site;

e. Requirements for pre-task safety and

health analysis;

f. Lines of authority; Organizational

chart
g. Policies and procedures regarding
noncompliance with safety requirements
(to include disciplinary actions for
violation of safety requirements) should
be identified;

h. Communication plan

i. Provide written company procedures

for holding managers and supervisors
accountable for safety.

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9. Subcontractors and Suppliers. If
applicable, provide procedures for
coordinating SOH activities with other
employers on the job site:

a. Identification of subcontractors (if

known)

b. Requirements for contractor to

review, approve and incorporate
subcontractor safety plans, risk
assessments, and method statements into
the contractor's safety management
system

c. Arrangements for monitoring

subcontractor performance (pre-
qualification, on-site monitoring,
penalties)

d. Arrangements contractors shall use to

control and ensure acceptable safety
performance of visitors and delivery
personnel (e.g. vendors, suppliers) that
may enter the worksite (e.g.
induction/visitors log)

e. Safety responsibilities of
subcontractors.

Accident Prevention. Contractor shall develop programs to support an accident free workplace. Elements include but are not limited
to: Training, Audits & Inspections, Method Statements, Risk Assessments, Safety Awareness, Meetings, Safety Incentives,
Employee Feedback

10. Training

a. Requirements for new hire safety

induction training at the time of initial
hire of each new employee.

b. Requirements for Pre-Work Briefs,

Toolbox Talks, General Awareness
Training, Skills Training and Formal
Training

c. Procedures for periodic safety and

health training for supervisors and
employees.

d. Requirements for emergency response

training.

e. Mandatory specific training &

competency requirements including but
not limited to:

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 - Electricians
- Mobile plant & vehicle operator
- Crane & lifting appliance
operators
- Riggers
- Excavation Supervisors
- Machinery Operators
- Scaffolders
- Scaffolding Supervisors
- Confined Space Workers
- Confined Space Supervisors
- All persons working at height

11. Non-Conformance, Corrective

Action & Prevention

a. Requirements for HSE

audits/inspections including but not
limited to: when inspections will be
conducted, who will is responsible for
conducting inspections, procedures for
documentation, deficiency tracking
system, and follow-up procedures.

b. Arrangements for external

inspections/certifications that may be
required (e.g., MOL, Supreme Council
of Health).

12. Method Statements & Risk

Assessments

a. Requirements for the assessment of

risks to the health and safety of their
employees as well as other people (e.g.
adjacent contractors, visitors, suppliers,
public, client) that may arise out of work
activities. Template should be included
as an appendices.

b. Arrangements for conducting a

contract risk assessment at the beginning
of the contract.
c. Requirements for the development of
risk assessments/Job Hazard Analysis.
Copies of templates should be included
as appendices.
d. Risk matrix included in procedures or
appendices
13. Incident Report
a. Requirements for the reporting and
investigation of all incidents which
caused death, personal injury or property
damage.

b. Arrangements for effectively

managing any emergency incident that
may occur as a result of work and/or on
the worksite.

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c. Arrangements for emergency
preparedness including, but not limited
to, medical equipment and facilities,
trained personnel, communication
systems, transportation, search and
rescue equipment.

d. Requirements for the submission of

monthly performance reports and
incident reports to the Engineer (e.g.
Supervising Consultant)

14. Safety Awareness

Arrangements to provide safety

awareness to workers through various
means including, but not limited to:
Notices, Posters, Newsletters, Booklets
& Alerts.

15. Safety Incentive Program

Arrangements to reward contractor

personnel, subcontractors or areas of
work that demonstrate exemplary
performance.

16. Safety Meetings

Arrangements including details of all
meetings that are held to specifically
deal with Occupational Health and
Safety issues.

17. Employee Feedback

Arrangements to allow employee

feedback on safety program issues. This
can include, but not be limited to:
Meetings, Suggestion Boxes, Surveys,
Focus Groups
18. Key Performance Indicators &
Continual Improvement
KPI's are established along with
arrangements to ensure management
review and continual improvement of
HSE Program

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19. Management Arrangements &
Standards. Based on a risk assessment
of contracted activities and on
mandatory compliance programs, the
Contractor shall address all applicable
occupational risks including at a
minimum, but not limited to:

a. Scaffolding

b. Suspended Work Platforms

c. Fall Prevention & Fall Arrest

d. Excavations

e. Electricity

f. Structural Steel Erection

g. Demolition & Dismantling

h. False work & Formwork

i. Reinforcement & Concreting

j. Cladding & Roof Work

k. Confined Spaces

l. Lifting Appliances & Lifting Gear

m. Mobile Plant & Vehicles

n. Mobile Elevating Work Platforms

o. Construction Lifts

p. Machinery & Equipment

q. Power Tools

r. Hazardous Substances
(COSHH/HAZCOM)
s. Hot Work & Welding

t. Fire Prevention & Protection

u. Access & Egress

v. Housekeeping

w. Warning Signs & Barricades

x. Material Handling, Transportation &

Storage

y. Lockout/Tagout

z. Temporary Works

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aa. Temporary Facilities

bb. Underground & Overhead Utilities

cc. Working Over or Adjacent to Water

dd. Working Environment

ee. Personal Protective Equipment

ff. Site Traffic Control

gg. Drug & Alcohol Prevention

hh. Radiation Safety

ii. Lead & Asbestos

jj. Abrasive Blasting

kk. Heat/Cold Stress Monitoring

ll. Crystalline Silica Monitoring

mm. Night Operations

nn. Excavation & Trenching

oo. Pre-Cast Concrete

pp. Pre-Employment & Periodical

Medical Screening of Workers

Overall Review Comments:

HSE Plan Acceptance Signature:

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