MARAFIQ –SAUR OPERATIONS & MAINTENANCE COMPANY (MaSa)

CONTRACTOR’S SAFETY COMPLIANCE STATEMENT

No: MaSa-QHSE-SF-002

We are in receipt of relevant MaSa & Marafiq Safety Procedures.

We nominate Mr. ___________________________________________, as Manager and
Mr. ___________________________________________________________as Authorized Permit Receiver
(APR) to receive Permit to Work Certificate for contract works. They will be responsible persons to:
1. Conduct Contract Work ________________________________________________________________
Ref No: ___________________ in MaSa O&M area ____________________________ in safest manner.
2. Liaise with MaSa QHSE Department - Safety Section and MaSa / Marafiq Coordinating Department
3. Submit contractor Safety Plan with Key Performance Indicators and monthly safety performance report
4. Comply with all MaSa & Marafiq Occupational Health & Safety procedures, manual and plan.
We shall:
i. Engage competent employees having attended Marafiq / MaSa Safety Induction course and possessing
Marafiq IDs prior to bringing them on MaSa O&M areas.
ii. Follow MaSa & Marafiq safety requirements and maintain good housekeeping.
iii. Inform our employees of hazards, risks and safety precautions to prevent undesired incidents.
iv. Appoint competent operators of cranes, forklifts and other mobile plant and vehicles having necessary driving
licenses or certificates as per statutory requirements.
v. Provide safe tools, work equipment and appropriate Personal Protective Equipment including essential safety
and emergency equipment to our employees.
vi. Control hazardous chemicals on site in all respects of use, storing, handling, transfer, etc..
vii. Report all incidents to MaSa QHSE Safety section immediately and strive hard to prevent undesired incidents.
We understand that any violations of MaSa or Marafiq safety rules and regulations may result in disciplinary action
as being removed from site and / or the contract being terminated
Contractor: Address:
Contractor Manager name: Signature Telephone /Mobile

Supervisor Name Telephone/ Mobile

Contract Number Seal of the Company

MaSa / Marafiq Coordinating Department: IP #

Coordinating Engineer Name Signature:
Date: