Attachment - 7

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SCAFFOLDING PERMIT PTW NO.

PTW APPLICATION: To be requested by the Receiver

Subcontractor Date of Application Other PTW Required

Applicant Name Date Time

Details of Work:(Method Statement, Risk Analysis attached) Work Location:

Presence of any U/G services YES NO

If yes describe Kind of U/G services and Dwg attached

Expected Work Period: Equipment & Tools to be used:

From Hrs. To Hrs. Date:

No. of Workers:
From Hrs. To Hrs. Date:
Date:
Name of Task Supervisor & Signature Description of Hazards anticipated

Company

Name

Signature

Company:

HSE REQUIREMENTS: To be filled in by the Issuer and reviewed by the HSE Dpt.

Item Yes No N/A Remarks

Authorized MS and Risk Assessment attached

Life Line provided

All workmen provide with Double lanyard Safety Harness

Erection/Dismantling procedures explained to all members

Scaffolding materials are good without damage, rust etc.

Areas below and around where overhead works are in
progress roped off to restrict unauthorized entry

Ladders available for ascending or descending

Watchmen (Look0out) assigned at the barricade.

Lifeline to be furnished

PTW VALIDITY: To be filled in by the Issuer PTW ACCEPTANCE: To be accepted by the

Receiver.
Permit Approval: I understand and agree to implement all Safety
measures stated in the PTW and comply with any
r
instructions for safe working practices.
Time: Hours to Hrs.
Validity of the Permit:

Date: From To Permit Received by:

Reviewed by BIN QURAYA EST. Line Supv.) Company

Name: Signature Name

Approved by (BIN QURAYA EST. Area SUP.) Signature

Name Signature Date & Time

PTW CONCURRENCE : (BIN QURAYA EST. Use Only) To be concurred by applicable discipline

Civil Section : Name Sign Date/Time Pip Section: Name Sign Date/Time

Elec. Section: Name Sign Date/Time Inst. Section: Name Sign Date/Time