NEOM Operations –Public
Facilities Management
Night work Permit
Permit No.: Date Applied:
DOCUMENTATION REVIEW
Section – I General Information
Permit Category Standard Operational Emergency / Urgent
Work area barricaded/ isolated with
Communication tools such as mobile
3 proper signage and flashing / 10
radio, walky-talkies available?
beckon light?
Safe Workplace regard to Lighting,
4 Continuous supervision maintained at
ventilation, and access? 11
site?
Employees briefed on the Risk
5 Assessment and work environment All mandatory PPEs provided,
12
at night? checked and in good conditions?
Hi-visibility jackets with reflective Drinking water, rest area and toilet
13
6 strips provided to all employees provide?
working at night? 14 First Aid box available at site?
Hard barriers installed with beacon
Employee work rotation planned 15 lights and banksman appointed when
7 work next to roadways?
and followed?
Others
Emergency arrangements in place, Refer to other control measures cited in RAMS.
8 communicated and understood?
Hard Safety Safety
Personnel Protective Equipment (PPE) Goggles Coverall
Hat harness Shoes
Others (please specify). Refer to Section 3 of RAMS.
Safety
Respirator / Mask Vest
gloves
Section – III Permit Requester
I have personally inspected to ensure that all requirements & precautionary measures as mentioned above have been fulfilled.
Mukhtar@diamond-
Name Email
Signatur north.com
e Mobile
Designation 0538815586
No.
Contractor
Name Mobile No. 508385970
Email Signature
Name Mobile No. 0594147373
Designation Remarks
Name Mobile No.
Designation Remarks
Name Mobile No.
Designation Remarks
Section – V NEOM FM H&S Dept.
Remarks: This activity requires Joint Site Inspection. Refer to Section VI.
Fahad.
Name Fahad qayyum Email
qayum@neom.com
Mobile
Designation Lead PTW Controller 0549709045 Signature
No.
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NEOM Operations –Public
Facilities Management
Night work Permit
JOINT SITE INSPECTION
Section VI Joint Inspection (Onsite)
Work will only commence after a HSFA site visit ensuring compliance with section II of the PTW and the controls advised within
the Risk Assessment & Method Statement (RAMS)
Remarks:
Permit Requester NEOM Proponent NEOM FM – H&S
Name Name Name
Signature/Date Signature/Date Signature/Date
Section – VII Holding/ Stoppage of work
Reason (Holding / Stoppage) Stopped by Time Informed to Restarted time Signature
Section – VIII Extension
The work is not completed, and the renewal of permit requested for additional hours.
Reason for extension
From To Total
Additional days from
(Date) (Date) Days
From To Total
Additional hours from am / pm am / pm
(Time) (Time) time
Requestor
Name Email Mobile No.
Signatur
Designation Remarks
e
Approval (NEOM Proponent)
Name Email Mobile No.
Signatur
Designation Remarks
e
Approval (FM – H&S)
Name Email Mobile No.
Signatur
Designation Remarks
e
Section – IX Permit Closure
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 Requester NEOM Proponent NEOM FM – H&S
Name Name Name
Signature/Date Signature/Date Signature/Date
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