PERMIT NO. H-575283 LOGBOOK No.

QATAR FOUNDATION Date Start: 2022-07-28

UNIFIED PERMIT TO WORK Date Upto: 2023-02-28

Work Permit (Hot Job / Work at height / Confined space)
Section: 1 (By Permit Applicant)
Work Request No: PTW-PD-TDESHMUKH ELEC MECH HVAC INST CIVIL LOGISTICS PROJECTS EVENTS
LOCATION: Faculty of Islamic Studies (Minaretein) WORK AREA: Qatar Faculty of Islamic (Minaretein) EQUIPMENT:
DESCRIPTION: (USE BLOCK LETTERS)

CPR-7170169 SHELL SPACE FIT-OUT MODIFICATION QFIS FOR WATER SUPPLY WORKS.

RISK ASSESSMENT IN PLACE ATTACHE Yes PERMIT APPLICANT

ENVIRNOMENTAL ASPECTS AND IMPACT No NAME Tausif Deshmukh
LlIFTING PLAN OR DEMOLITION PLAN No DESIGNATION Senior Project Coordinator
CONFINED PLAN ATTACHED No SIGN APPLIED
PERSONAL PROTECTIVE EQUIPMENT(P Yes DATE 2022-07-28
  TIME 08:30:10
  CONTACT TELEPHONE
  OTHER DETAILS
Section: 2 (By Permit Authority) Tick Relevant Boxes
PRECAUTION PROTECHTIVE EQUIPMENTS PERMIT AUTHORITY
ELECTRICAL ISOLATION No SAFETY GOOGGLES Yes NAME Saoud Al-Rumaihi
MACHANICAL ISOLATION No GLOVES Yes DESIGNATION Facilities Manager
PURGING OF SYSTEM No DUST MASK Yes SIGN AUTHORIZED
DISCONNECTION / BLIND No EAR PLUG Yes DATE 2022-08-17
OVERRIDES Yes SAFETY HELMETS Yes TIME 07:23:37
EXCAVATION No SAFETY HARNESS Yes CONTACT TELEPHONE 44541132
SCAFOLDING No   OTHER DETAILS
OTHER PRECAUTIONS
Section: 3 ISOLATION / DE-ISOLATION
Mechanical: Isolation/De-Isolation Electrical/Instrument: Isolation/De-Isolation
ISOLATION DE-ISOLATION DEVICE ISOLATION DE-ISOLATION
                 
                 
Sign Time Sign Time Sign Time Sign Time
                 
Section: 4 (RESPONSIBILITIES / DECLARATION IN THE BACK)
PERMIT CONTROLLER WORKSITE SUPERVISOR HSSE APPROVED OFFICER (As APPLICABLE) TRAM PASSENGER SERVICE APPROVAL
NAME Mohammed Festok Aamir Alam Rochive Fuentebella
DESIGNATION Facilities Head Site supervisor Safety Supervisor
SIGN ISSUED REVIEWED
DATE 2022-08-17 2022-08-16
TIME 11:22:22 13:57:14
CONTACT TELEPHONE 31290333 44541219
OTHER DETAILS
Section: 5 VALIDATION AND RENEWALS
BUILDING FOCAL POINT ENDORSMENT: DAILY NOT REQUIRED
NAME Rasheed Payanthongil
DATE 2022-08-17
TIME 08:02:19
SIGN ENDORSED
As authorized building PTW Focal Point I understand and acknowledge the impact of this PTW and I am fully aware of my roles and responsibilities.
PERMIT CONTROLLER DAILY ENDORSMENT
NAME
DATE
TIME
SIGN
ISOLATION / DE-ISOLATION (FM USE ONLY)
ISOL DE-ISOL ISOL DE-ISOL ISOL DE-ISOL ISOL DE-ISOL ISOL DE-ISOL ISOL DE-ISOL ISOL DE-ISOL
NAME
DATE
TIME
SIGN
Section: 6 CLOSURE / CANCELLATION
Permit is CLOSED - Job is to be continued of New Permit No.
Permit is CLOSED - Job is Completed, House keeping is restored to Normal / System Reinstated
Permit is CLOSED - Permit Cancelled as present conditions are not valid
Worksite Supervisor Permit Applicant Permit Controller
NAME Aamir Alam Tausif Deshmukh Mohammed Festok
SIGN
DATE
TIME
Permit Authority
NAME Saoud Al-Rumaihi SIGN
DATE TIME
IN CASE OF EMERGENCY CALL 44540999
Section: 3 ISOLATION / DE-ISOLATION Continue
ISO Work Details De-ISO Work Details
ISO/De-ISO Type Location / Equipment
WR ID Date Time WR ID Date Time