#
WSCM-005
WELLSITES DIVISION
AUTHORIZATION TO WORK
Construction Unit: Date: Rig:
Well Location: - Well Type: Contractor:
Work Type:
Expected Work Start Date: Expected Work Completion Date:
CONTRACTOR must obtain Permit To Work (PTW) when working within 23m of
wellhead or flow line, also within 15m of overhead power lines.
CONTRACTOR SITE REQUIREMENTS
1 Comprehensive Site Specific ERP, HIP, & JSA aligned with all probable scenarios and Medivac Plan including
nearby Hospitals. All Documents signed. N/A YES
2 Contractor Conducted Pre-Job Safety meeting, reviewed / discussed the HIP, JSA, ERP & Restricted Area's with
N/A YES
all required site personnel and translated for all to understand.
3 Working area surveyed for Wellhead, Above Ground Pipelines, Power Lines and that Under Ground and existing
N/A YES
utilities have been marked.
4 Identify where PTW are required and highlighted restricted areas. _______# of PTW required. N/A YES
5 Hard Barrication (drums) required around the Wellhead, Above Ground Pipelines & Power Lines. N/A YES
6 Barrication & Warning tape indicating the permitted work location secured. N/A YES
7 Hard Barrication & warning tapes indicating Restricted area's stockpile of Marl collection highlighting all nearby N/A YES
hazards.
8 Flagmen placed to control the movement of equipment near pipe/power lines and wellheads. N/A YES
9 Saudi Aramco Certifications in-place for all Heavy Equipment Operators. N/A YES
10 First Aider available on site. First Aid Kits available & stocked. N/A YES
11 The Foreman should know his roles & responsibilities as Incident Commander and assigned to this location only. N/A YES
12 All in compliance with required PPE (Hard hat, safety shoes, Safety glasses and gloves). N/A YES
13 Shaded areas available for workers with additional water (igloo). N/A YES
14 911 Call Sheet, ERP, Medivac Plan posted on stand (Sign Board). N/A YES
15 Heavy Equipment in good working condition with daily H/E checks conducted including Fire Extinguishers checked
N/A YES
& Seat bealts in use.
Being Contractor Representatives I, Hereby Acknowledge All Hazards Identified As Shown Above. Whereas, Totally
Understand And Agreed To Abide By The Procedures Required To Complete The Work in Safest Possible Manners.
Contractor Site Foreman Contractor Safety Advisor
Wellsites
Wellsites Representative - Badge #
Last Updated on January 01, 2022
# Saudi Aramco: Company General Use
