3977 - Dubai Shipbuilding & Engineering

PERMIT NO.
OCCUPATION OF WORK SITES PERMIT 3977
SECTION 1 – SCOPE OF WORK (TO BE COMPLETED BY THE AUTHORISED PERSON)
Applicant: (Firm Name if Applicable) M/s Dubai Shipbuilding and Engineering

Contact Number: +971 52 9033534
Location of Work: MR Marina
Description of Work to be Done: Rebalancing the fuel station
Duration Permit Start: Finish:

17 / 07 / 2024 07: 00 23 / 07 / 2024 18: 00
Valid (Date/Time) (Date/Time)
SECTION 2 – HEALTH, SAFETY AND ENVIRONMENTAL (HSE) PRECAUTIONS REQUIRED / TO BE OBSERVED:

(TO BE COMPLETED BY THE AUTHORISED PERSON)
√ MEANS THE MINIMUM HSE PRECAUTIONS REQUIRED AND TO BE OBSERVED AND ADHERED TO.
√ Personal protective equipment to be provided and worn when entering and whilst in the work area:
√ High visibility outer garment √ Head protection √ Safety footwear □ Full body Safety harness □ Life jacket mandatory working near jetty.
√ Continuous competent supervision to be provided.
√ Personnel to be transported by motor vehicle where applicable. No pedestrians are permitted to walk within the cargo handling areas & no walk zones.
√ Motor vehicles are provided with a clearly visible amber flashing light and switched on.
√ Suitable barricading/isolation which ensures the protection of pedestrians and equipment relating to both contractor and DP World activities is to be
always in place at the worksite.
√ Signage to be prominently displayed and maintained which warns of the works being undertaken at the worksite.
√ A banner man / flag man to be deployed at the work site to physically indicate operators/drivers of all mobile equipment deployed in the area
the presence of pedestrians (workers).
√ In case of any emergency, call DP World Command Control Centre (CCC) at 800 379222/04 887 4000 and notify your DPW Area Supervisor.
√ Other (Specify) Weather conditions to be considered – Life jacket must be worn by all workers involved
SECTION 3 – WORK AUTHORISATION
Authorised Person:
This certifies that I have consulted with all relevant departments/sections concerning the occupation of the work site as detailed in Section 1 of this form,
including the scope of work and precautionary measures to be observed and adhered to by the Work Permit Acceptor.
Name: Sultan Othman______________________________ Signature: ________________________________________ Date: 17/ 07 / 2024

Contact Numbers: (Office) __04 8897410__________________________ (Mobile)______ +971 56 4337204______________
Work Permit Acceptor:
This certifies that I have been informed and understand the hazards associated with the occupation of the work site(s) including the precautionary
measures that must be observed and adhered to with regards to those hazards. I further undertake to ensure that all staff under my control are made
conversant with the precautionary measures required to be observed and adhered to regarding the occupation of the work site(s).
I accept responsibility as the person directly in-charge of the work and agree to be bound by the conditions listed above.
Name: Mr Shazad Khan _______________________ Signature: _________________________________________ Date: 17/ 07 / 2024
Contact Numbers: (Office) 04 586 5200____________ (Mobile) _____+971 52 9033534_______________________________________
DPW Area Supervisor:

This certifies that I have been informed of the work site to be occupied including the precautionary measures that must be observed and adhered to by
the Work Permit Acceptor:
Name: Mr. Khaled Ahmad Eslami ______________ Signature: ____________________+971 56 676 2582 ____________Date: 17/ 07 / 2024
SECTION 4 – CLOSING OF PERMIT (TO BE COMPLETED BY THE AUTHORISED PERSON)
All works associated with this work permit have been: (Please tick) Completed Cancelled Suspended
All personnel have safely left the work site: Yes No
Authorised Person:
Signature: Date: Time:
Distribution:
White Copy (Original) - Work Permit Acceptor Blue Copy (First) - DPW Area Supervisor Pink Copy (Second) - Authorised Person
Revision:4
ALL COMPLETED PERMITS MUST BE RETURNED TO THE POINT OF ISSUE TO ENABLE CLOSURE OF
DPW-UAE-HSEMS-OHS-PCD-06 -F01 Page 1 of 1
THIS PERMIT AND FILING FOR RECORD Revision Date:
12/12/2021

3977 - Dubai Shipbuilding & Engineering

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PERMIT NO.

OCCUPATION OF WORK SITES PERMIT 3977

SECTION 1 – SCOPE OF WORK (TO BE COMPLETED BY THE AUTHORISED PERSON)

Applicant: (Firm Name if Applicable) M/s Dubai Shipbuilding and Engineering

Description of Work to be Done: Rebalancing the fuel station

Duration Permit Start: Finish:

SECTION 2 – HEALTH, SAFETY AND ENVIRONMENTAL (HSE) PRECAUTIONS REQUIRED / TO BE OBSERVED:

SECTION 3 – WORK AUTHORISATION

Name: Sultan Othman Signature: __________ Date: 17/ 07 / 2024

Name: Mr Shazad Khan _ Signature: ___________________ Date: 17/ 07 / 2024

Contact Numbers: (Office) 04 586 5200__________ (Mobile) _+971 52 9033534_____________________________________

DPW Area Supervisor:

SECTION 4 – CLOSING OF PERMIT (TO BE COMPLETED BY THE AUTHORISED PERSON)

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