DEVELOPER PMS CONSULTANT CONTRACTOR
MAIN CONTRACTOR : AL SERH AL KABEER CONSTRUCTION LLC. FT-HSE-ASAK-0
PROJECT DETAILS : WT+6B+G+105+RF Residential Clock Tower, Plot No. 392-198, Marsa Dubai. UAE
PROJECT NAME Franck Muller – AETERNITAS
Permit Type & No. PRESSURE TEST WORK PERMIT DATE:
Project Location & Plot No. PERMIT NO:
Description of the work: Hydrostatic Pneumatic Others (specify): MSRA NO:
Location of Work
Requesting Contractor/Company
1. Permit issuance details: (To be filled by Requster/Holder)
THIS PERMIT IS ONLY FOR ONE SHIFT AND NO EXTENDABLE
S# Description Yes No NA Description Yes No NA
1 Assigned test pressure known and not exceeded 8 Pressure gauge calibrated and certificate
available?
2 Electrical panels and pumps nearby are covered by 9 Is system properly vented while filling and
appropriate means to avoid the splash of water over it depressurization.
3 Designated persons for the pressure testing 1 Pressure testing area cordoned off with
competent 0 appropriate warning signage
System inspected before testing, isolations, blinds and 1 Proper working platform and access provided
4 other specified safety devices are in place. 1 for work to be carried out at height. Full body
safety harnesses available
5 Other employees working nearby have been alerted 1 Considered hazards from the other routine/
NOT to disturb the system under pressure 2 operations & concerned persons alert
6 Any energized power lines, if any in the vicinity, shall 1 Floor opening, if any, covered?
be de-energized. 3
7 Workmen have been briefed on the hazards, 1 The area properly ventilation and lighting
precautions in place and emergency procedures before 4 provided
testing starts
3. ISSUE OF PERMIT- AUTHORISATION / RECEIPT
PERMIT HOLDER (name) I declare that I accept full responsibility for Signature
carrying out work detailed in this permit
including all Health & Safety precautions
required.
PERMIT COORDINATOR (name) I declare that this permit was properly Signature
fulfilled, and it is ready to be
revised/reviewed by the Permit Authority.
PERMIT AUTHORITY (name) I declare that I consider the permit holder Signature
competent to carry out the work and the
work described may now be authorized.
4. DAILY SITE CHECK BY PERMIT HOLDER -Signature is confirming it is safe to work and all Health & Safety Precautions required by the permit are
implemented at work location.
Name & Designation Date & Signature
5. DAILY SITE CHECK BY HSE OFFICER -During daily routine, I checked and found work condition safe at the work location.
Name & designation Date & Signature
6. PERMIT CANCELLATION
Name & designation Date & Signature
7. PERMIT CLOSE-OUT
Name & designation Date & Signature
DEVELOPER PMS CONSULTANT CONTRACTOR
MAIN CONTRACTOR : AL SERH AL KABEER CONSTRUCTION LLC. FT-HSE-ASAK-0
PROJECT DETAILS : WT+6B+G+105+RF Residential Clock Tower, Plot No. 392-198, Marsa Dubai. UAE
PROJECT NAME Franck Muller – AETERNITAS
INVOLVED TEAM TBT TO BE CONDUCTED PRIOR STARTING ACTIVITY
S.N NAME COMPANY ID NUMBER DESIGNATION SIGNUTRE
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1. This permit must be closed out properly and returned to Site HSE Office immediately after the completion of work
2. The permit valid only for the day, time and period stated above.
3. The condition of issue must be complied with throughout the duration of work.
4. The permit may be withdrawn/ reissued if conditions (equipment, weather, and/or ground) or scope of work has changed or
violations permit requirements.
5. Permit must be posted at the pressure testing location until testing is complete.
IN THE EVENT OF AN EMERGENCY CONTACT SITE HSE OFFICE
