PIC-PT-7719 (13M) Project

Section:1 - PROJECT DESCRIPTION & EMERGENCY CONTACTS

Work timing: Start: 7 AM Complete: 6 PM
*No work allowed after 6 PM in what so ever circumstances*
Work Location 10J SS
Scope of Work Installation of 115kV GIS Extension
Installation of Cable tray
LV cable pulling & termination
HV Power cables
Fiber Optic cables

Section: 2 - FOR ALL EMERGENCIES CALL:

Emergency Contact number (RC) : 9111
Marafiq: 6333
Civil Defense: 998
Ambulance: 997
For all incidents, injuries, property damage, near-misses, work-induced illness or chemical over-exposures, the following personnel MUST
be immediately contacted upon scene stabilization, but in all cases within one hour:
Project Personnel Name Phone Number(s) Email
UG Construction Manager Saeed AlZahrani 0532967345 [email protected]

Safety Engineer AbdulMuhsen Al-Shehri 0542362671 [email protected]

OTHER CONTACT INFORMATION
Marafiq Approved APR Romer Castillo 0559724994
(Available at Site)
Marafiq Approved Safety AbdulAziz AlMowaled 0557953934
(Available at Site)
Required Documents Method Statement, DRA PTW
Additional Required Personnel First Aider: Asif Ali

SECTION 3 - SAFETY BRIEFINGS AND INSPECTIONS

Safety Briefings location, time, frequency: To be recorded during execution of work

Documents Required prior to work: PTW, MoS, DRA (To be verified prior to execution of work by APR & Safety)

Documented Safety Inspections conducted by:

 SITE SPECIFIC SAFETY PLAN (SSSP) PART 2

Section : 4 (Site requirements and verification)

Yes No Hazard/Activity with specific -based control measures.

Asbestos use, alteration, removal or storage  

(Identify your Competent Person for Asbestos Work here)

Blocking Exits or Exit Pathways 

Surface Penetration  
Confined spaces 
Crane Use  
(Identify your Lift Supervisor here)

sanitary/septic system in place

Energized electrical work (>50 v or > 50 mA)  

Excavation  
(Identify your Competent Person for Excavations here)

Equipment for excavation checked

Falls from elevation (work at heights > 6 feet) 

(Identify your Competent Person for Fall Protection here)

Fire protection  
Flushing of waterlines, storm/sanitary lines, fire suppression systems or fire
hydrants will be performed
Hazardous Waste Storage or generation on construction site 

Yes No Hazard/Activity with specific -based control measures.

Hoisting/Rigging 
(Identify your Hoisting/Rigging Competent Person here)

Hot work  
Lasers. (Class 3B and 4)  
Lead concerns 
(Identify your Competent Person for Lead work here)

Lockout/Tagout (Control of Hazardous Energy) 

Night work
 SITE SPECIFIC SAFETY PLAN (SSSP) PART 2

Outdoor work to be performed between mid-March and mid-September

Silica Concerns

Radioactive materials or Ionizing radiation-generating devices

(Identify your Radiation Safety Officer here)

Scaffolding 
(Identify your Scaffolding Competent Person here)

Structural Steel Erection 

Traffic Control 
Underground Construction 
Wetlands, drainage channels, streams, groundwater seeps occur within
construction site

SECTION 6 - PROJECT SUPPORT FEATURES, SITE CONTROL & LOGISTICS

Check all of the following facilities and equipment that are required for safe completion of work.
Facility/Equipment Description
Sitting facility with table to
complete documentation
Materials Receiving Location
Portable Restrooms/wash stations
Supplementary Illumination
Emergency Eyewash/Shower
First Aid Supplies
Fire Extinguishers
Hazardous Material Storage
Spill Containment/Clean-up

SECTION 7 – REQUIRED TRAINING/QUALIFICATIONS

Training Records Location:
Identify where you will maintain training/certification records related to your Project at :
Identify the activities involved on your project which have OSHA-required training:
Yes No
Asbestos activities
Aerial Lift Operation
Crane Operation (minimum NCCCO certification for operator)
 SITE SPECIFIC SAFETY PLAN (SSSP) PART 2

Confined Space Entry

Electrical Work requiring NFPA 70E provisions
Electrical Work requiring CPR-trained 2nd worker
Excavation
Fall Protection Equipment
Forklift Operation/Powered Industrial Truck Use
Heavy Equipment Operation List equipment to be used:
Ladder Use
Lock-Out/Tag-Out
Noisy Operations requiring Hearing Conservation training
Scaffolding Erection, Use
Respirator use
Power tools
Required site specific training
Electrical works
Construction Orientation
Excavation safety
Use of power tools

SECTION 9 - PLAN ATTACHMENTS

For each activity or hazard checked in Section 5, list and attach your additional corporate, site- or project-specific programs/plans.
Attachment Reference Procedure or Program
1 DRA for
SITE SPECIFIC SAFETY PLAN (SSSP) PART 3
 SAFETY PLAN

Project name: 13M Project

Safety plan review

Prepared by: (HSE Manager) Reviewed & Approved by: Construction Manager Reviewed & Approved by: Project Manager
Wajahat Ali, HSEM Saeed Y. AlZahrani, CM Moukhles Sharbek, PM

Signature and date Signature and date Signature and date

Marafiq Approved DRA & PTW Attached: Yes No

Definable Work Activity: Enter Activity Title

Control Measure(s), Required Training, -required Permits or Plans,
Work Task Potential Hazard(s)
and Competent Person(s)

PRE-TASK BRIEF ATTENDANCE ROSTER

By signing below, I agree to the following:
 I agree to follow the work steps and implement the controls as written.
 I agree to stop work when conditions or hazards change or when I encounter unexpected conditions during the execution of work, or when work cannot be performed as written, or
instructions become unclear during execution.
 I confirm that I am authorized, qualified and fit to perform the work.
Worker (Print /Sign / Date) Worker (Print /Sign / Date)

Worker (Print /Sign / Date) Worker (Print /Sign / Date)

Worker (Print /Sign / Date) Worker (Print /Sign / Date)

Worker (Print /Sign / Date) Worker (Print /Sign / Date)

SITE SPECIFIC SAFETY PLAN (SSSP)