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Time

NAME: SIGN: DATE: TIME:

NAME: SIGN: DATE: TIME:

ABU DHABI SEWERAGE SERVICES COMPANY ( ADSSC

O-1696 - Relocation & Upgrading of Existing W7 Pumping Station and Force Main

Consultant: AECOM Middle East Limited Contractor: EMCO Engineering Inc., Emirates LLC

LIFTING PERMIT

Contractor: EMCO ENGINEERING Permit No. Date:

PO Box: 1419 PO Box: 4750

Al Ain United Arab Emirates Abu Dhabi, United Arab Emirates

Permit validity period Date

Safety Approval: Conditions of issue which must be observed at all times.

Location of the work

Description of work

Competent Lifting supervisor / Rigger available. Lifting machine is in good condition.

Access for Crane is in good condition. Tool Box Talk meeting records.

Valid third party certificate available for Crane. Warning sign board positioned.

Valid third party certificate available for Lifting Gears. Competent Crane operator available.

Sitting distance from excavation / Trenches______ meter and roped

off with warning sign.

Inspection check list by Crane operator and Lifting

supervisor availabe.

Warning alarm and lights are function properly.Sitting distance from overhead power cables and

roped off with warning sings.

Limit switches are functioning properly. Crane must not be left unattended.

Load radius indicator is in good condition. Lifting area cordoned off.

I have personally chekeded all the above mention requirements and request for the approval of the lifting operation.

Name of Supervisor_________________________________ Signature: __________________Date:___________

HEALTH SAFETY & ENVIRONMENT DEPARTMENT:

Rigger / signal man with proper attair.

Item required & complied (¥), Item requird & not complied (X), Item not applicable (N/A)

Endorsement by Lifting Operator/ Supervisor

I confirm that I fully understand and will implement all the safety requirements detailed in this permit and that all those under my control will

Project Manager Name:_____________________________ Signature: _____________________ Date: ______________

I have personally checked the site and conditions and permission is granted for work to commence under all the above mentioned precautions

Name of Engineer________________________________ Signature: __________________Date:___________

MANAGEMENT

RECEIVER ( Contractor)

Note: This Lifting permit is valid for one ( 1) day only - and may be cancelled without notice at any time.

AUTHORIZATION:

ISSUER ( Consultant)

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