HEALTH, SAFETY & ENVIRONMENTAL (HSE)
LIFTING OPERATIONS PLAN & PERMIT Form ID: NBHH-HSE-FM-002-A Rev. No: 01 Date: 01-07-2024 Page 1 of 2
AL HUDAYRIAT ISLAND PDA INFRASTRUCTURE - INFRA 3A & 3B ABU DHABI
JOINT SITE INSPECTION IS REQUIRED WHEN ISSUING A PERMIT
Location: Permit No:
1. WORK DESCRIPTION
This permit-to-work (PTW) is to be retained by the Work In-Charge/Work performer while work is in progress and must be displayed in the
working area. A copy of this PTW must be retained by the issuing authority. After completion of job Return the signed, completed permit to
Issuing Authority for the hand-back procedure.
Name: Designation
Date & Time: Location
Work being Undertaken By: ☐NBHH ☐Sub-Contractor Company doing Lifting:
Lifting Equipment Owner: Other Parties Involved:
Type of Lifting
Work Description
☐ Routine ☐ Tandem ☐ Critical
2. PRECAUTIONS REQUIRED (To be filled by Permit requestor): Tick the required precautions
Lifting Hazard Signs Outrigger Pads Provided Outriggers Extension Acceptable Full supervision available/ appointed?
Access / Egress TPC of crane and lifting gears Crane Inspection Check List Barricaded around Lifting premises
Adjacent Operations Competent Crane Operator Safe Distance from Excavation Ground condition stable and compacted
Verify Load Capacity Fall, Slip, Trip Hazards Tagline provided Competent / Sufficient Riggers
Lifting operation over Crane anemometer and ASLI Communication System: Others:
road/highway/public functional ☐ Hand Signal ☐Radio
3. LIFTING TEAM
Appointed Person (Engr.) AP. Lic. Validity AP. TPC Validity Lifting Supervisor L.S. TPC validity
Operator Op. Lic. Validity Op. TPC Validity Rigger Name Rigger TPC validity
4. TYPE OF LIFTING EQUIPMENT
Make / Model Equip. Type Safe Working Load 3rd Party Cert. Dt. Load Chart Last Major Service.
Reg. Plate No. Boom Length SWL Indicator Fitted 3rd Party Cert. No. Known Defects
5. LIFTING GEARS (Lifting Supervisor to fill & sign this part)
S. No Item Type Lifting equip ID TPC Certificate No. TPC Expiry Date Safe Working Load
01
02
03
04
05
06
07
08
09
10
I have visually inspected above mentioned all lifting equipment and can use for this permit implementation only.
Name: Date: Sign:
6. SITE CONDITIONS
Ground soil condition: Ground Profile (in degrees)
Space for outriggers available? Warning Signs Posted?
Weather Conditions favorable? Wind Speed?
HEALTH, SAFETY & ENVIRONMENTAL (HSE)
LIFTING OPERATIONS PLAN & PERMIT Form ID: NBHH-HSE-FM-002-A Rev. No: 01 Date: 01-07-2024 Page 2 of 2
7. CRANE SET-UP CHECKLIST (To be completed by Operator)
S.NO ITEM YES NO
01 Crane set on level ground & outriggers fully extended?
02 Pick up and drop paths identified?
03 Rigging equipment inspected & correctly colour coded?
04 Lifting area isolated and controlled?
05 Daily crane checklist completed & safe to commence work?
Crane Manufacturer’s wind speed limit: ……………………. (Mtr./Second)
06
(if none stated, work suspended whenever wind speed reaches 9.8 m/s)
8. LIFTING PLAN (Lifting Plan shall be prepared by Lifting Appointed Person)
CALCULATIONS
A Mtrs.
B Mtrs.
C Tons
D Tons
Total Weight (T) (T = C+D) Tons
Max Weight Capacity (M) Tons
Utilization of Crane:
%
((T*100) / M)
Crane SWL Tons
9. Permit Request (Site Engineer)
Name of Work In-Charge: Nominated Work Performer Name:
I have personally viewed the area, assessed the hazards, and shall make sure that necessary precautions Designation: Date & Sign:
are implemented for this work. I nominated above mentioned foreman as work performer and have
made him and his team understood the requirements of this PTW and ensure their adherence to it.
10. Permit Authorization (Construction Manager)
I, as an issuing authority declare that the above work has been discussed with the person(s) in charge of Designation: Date & Sign:
the work, the risk assessment / method statement has been reviewed and all safety precautions /
actions required are in place have been inspected by myself in accordance with this PTW requirements.
11. HSE VERIFICATION
HSE Comments/Recommendations: Name & Designation: Date & Sign:
12. Revalidation of PTW
The maximum duration of this permit is 7 days, PROVIDING NO CHANGE TO THE TASK OR CONDITIONS HAS OCCURRED.
The Date, Time on and Time off must be completed and signed by the Issuing Authority and Work In-Charge to revalidate the permit.
Day – 2 Day – 3 Day – 4 Day – 5 Day – 6 Day – 7
Date
Time on & off
Lifting Supervisor
Sign – WI
Sign – HSE
13. WORK COMPLETION / CANCELLATION.
☐ All works Completed on this PTW, all persons, materials and equipment involved have been withdrawn and site left clean, tidy and safe.
☐ All works on this PTW has been suspended and PTW cancelled by HSE Responsible.
(Work In-charge) Name: Sign: Date & Time:
Authorized Person: Name & Designation: Date & Sign:
The work covered by this PTW is complete and the area has been left safe, clean,
and tidy.
IN CASE OF EMERGENCY PLEASE CALL PROJECT EMERGENCY NUMBER - +971 521 291 636
