Doc. No.

:
TIP-HSE-P03-02-F01 CONTRACTOR HSE CLEARANCE
Date:
2014 February
Revision: 0

Instructions
This checklist is intended to assist Contractors and Project Owners in complying with the Health, Safety and Environment requirements of Tawazun
Industrial Park. Once the requirements are completed by the contractor, the HSE Requirements shall be reviewed and approved by the Project
Owner’s HSE Department, acknowledged by TIP HSE Department, and forwarded to the Security Department before the contractor is allowed to
mobilize at site and start with the Project.
References:
1. Abu Dhabi EHSMS RF CoP 53.0 – EHS Management During Construction Works
2. Abu Dhabi EHSMS RF CoP 53.1 – EHS Construction Management Plan
3. TIP HSEMS TIP-HSE-P03 Management of Contractors
4. TIP HSEMS TIP-HSE-P03-02 HSE Management During Construction Works

Contractor Name Darwish Aluminium & Glass co LLC

Project Containment work for CC TV
Area / Zone Zone-1 Project No. NA
Responsible Person Gopalakrishnan Nair Contact No. +971565045928
Position Supervisor Email address info@darwsihglass.com

HSE Requirements Prior to Mobilization

Definition of Major Works:
1. When the Construction Works duration is equal to or exceeds 90 days; or
2. When Construction Works involves 100 staff or more at any time during the project; or
3. The Construction Work will involve 1,800 man days or more.
Definition of Small Works:
- Any maintenance, repair, etc. not involving any of the above descriptions
SMALL WORKS (Tick when Accomplished) MAJOR WORKS (Tick when Accomplished)
□ Risk Assessment based on Method Statement □ HSE Plan
□ HSE Representative Appointment □ HSE Representative Appointment
□ Arrangement for Induction of Workers □ Method Statement and Risk Assessment
□ Certificates of all Mobile Plant, Mobile Crane,
□ HSE Kick off Meeting
Lifting Accessories, if any
□ Certificates of Operators and Riggers where
□ Arrangement for Induction of Workers
applicable
□ Material Safety Data Sheet (MSDS) of Chemicals, if any □ Site Logistics and Establishment Plan
Notes: Notes:

Submitted by (Contractor): Verified by (Project Owner):

Name: Vijay Kushalappa Signature: Name: Ovidiu Mesaros Signature:

Company & Position: Director Date: 10-10-2016 Company & Position: Facility Manager Date

Approved by (Project Owner HSE Department): Acknowledged by (TIP HSE):

Name: Signature: Name: Signature:

Company & Position: Date: Company & Position: Date:

TIP-HSE-P03-02-F01 Contractor HSE Clearance R0