ABDUL MOSHEN A.
H AL TAMIMI & PARTNERS
NC-1 Neom Command Centre & Police Station
WORK PERMIT
Revision # 00 Date of issue June 30, 2022
COLD WORK PERMIT
Permit No.: Application Date:
Section 1. GENERAL INFORMATION
Requester Name: Work Location:
Contractor Name: Project No.:
Activity Description:
From (Date) To (Date) Total Days:
Work Permit
Coverage: To
From (Time) Total Time:
(Time)
Associated Work Permit (If
Cold Work Hot Work Excavation Lifting CSE
applicable)
Additional Permit No. (if
applicable)
Section 2. SAFETY REQUIREMENTS
Ye
Requirements Details No N/A
s
2.1 (JSA) Job Safety analysis
2.2 Risk Assessment & Method Statements (RAMS)
2.3 MSDS
2.4 Access and Egress
2.5 PPE’S Required
2.6 Sufficient Lightings (If needed)
2.7 Caution signs posted
2.8 Standby firefighting equipment
2.9 Safety instructions given to workers
2.10 Housekeeping & Material Arrangement
2.11 Lock-Out/Tag Out Required (LOTO)
Comments/Additional Controls:
2.12
Section 3. PERMIT OPNNING
Permit Issuer Contact Date
Signature:
Name: No.: :
Permit Receiver Contact Date
Signature:
Name: No.: :
Permit Control Contact Date
Signature:
Manager: No.: :
Section 4. AMT SAFETY DEPARTMENT
Contact Date
Name: Signature:
No.: :
Safety Comments:
Section 5. PERMIT CLOSING
Note: I hereby confirm the completion of the work and any alarm, electrical, valves, etc. isolations/ LOTO have been removed.
Work area is left clean, tidy and safe for operational use.
Permit Issuer Contact Date
Signature:
Name: No.: :
Permit Receiver Contact Date
Signature:
Name: No.: :
