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Permit to Work ______Third Party Emergency Work (Filled out by Qatar Rail) Company Management System

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Permit to Work ______Third Party Emergency Work (Filled out by Qatar Rail) Company Management System Qatar Rail QR-PERMIT Ref. # Permit to Work ____________________ Third Party Emergency Work (Filled out by Qatar Rail) Company Management System VALIDITY MAXIMUM 48 HOURS START DATE / TIME: FINISH DATE / TIME: Emergency Routes must be OPEN at all times (day/night) and must be provided immediately. MISUSE renders the Permit invalid and the applicant may be blacklisted, fined, and legal actions may be taken in accordance with Law 10/2014 and Law 14/2015 and relevant applicable laws. The Authority - certifies Authority Print name Mobile Email Stamp/Date/Signature 1. That the information contained in this application is true and complete. 2. Fully understands the documentation associated with this work activity, the hazards, the precautions required, obligations, and the procedures to carry out the work in relation to the rail interface. Ensure that the workforce undertaking the work activities are fully briefed, equipped, qualified and understand the safety and emergency procedures to be followed and are competent. 3. Provide unobstructed access/egress to Qatar Rail stations, emergency exits & associated buildings, land and work sites at all times and during all phases of the emergency work. 4. The authority has full responsibility & liability of their works and any negative impact on QR Operations/Work Activities and damage to Qatar Rail assets. 5. To implement the works in accordance with the relevant specifications, health & safety standards, and reinstates to the same quality standard as before. Excavate any trial pits and carry out any surveys required to ascertain the extent of existing utilities. Fully complies with QCS 2014 & Qatar Rail terms & conditions. CONTRACTOR Person in Charge Email Mobile EMERGENCY WORK Emergency Ref. / RO BLOCKAGE PIPE BURST CABLE DAMAGE ROAD DAMAGE OTHERS (specify) Type and Description of Work: Attached Information LOCATION PLAN PHOTOGRAPHS METHOD STATEMENT/RISK ASSESSMENT QATAR RAILWAYS (QR) COMPANY (APPROVING ENTITY) Red Line North EAG Red Line North UG Red Line South UG Red Line South EAG Lusail LRT Black Line UG Green Line EAG Green Line UG Gold Line UG Gold Line EAG Blue Line UG Major Stations Long Distance Commuter Line PHASE / LOT / CORRIDOR / LOCATION ____________________________________________________________________________________ Comments / conditions: (use separate page, if required) Stamp/Date/Name/Signature PERMIT ACTIVATION - ACKNOWLEDGE – CLOSING EMAIL & CALL NEAREST STATION MASTER ACTIVATION & ACKNOWLEDGEMENT RKH Qitarat DATE/TIME CLOSING RKH Qitarat DATE/TIME LEADING EXCELLENCE │CMS Ref.: TM-215-F25, 01/04/20, Rev. 1.0 Page 1 of 3 Qatar Rail QR-PERMIT Ref. # Permit to Work ____________________ Third Party Emergency Work (Filled out by Qatar Rail) Company Management System Terms & Conditions: 1. A Qatar Rail (QR) Emergency Permit to Work (PTW) to be filled out and submitted to Qatar Rail Governmental Interfaces & Permits Department (GIP). 2. As requested by GIP every Railway Party (i.e. QR contractors, service provider, etc.) interfacing with the Third Party Intended Work may be required to sign-off. Refer to QR contact list: QR Departments, QR Contractors, QR Operator & Service Provider. The Rail Operator/Service Provider access- and operational requirements to be complied with. 3. Qatar Rail representatives have the right to STOP WORK if any violation of the submitted documents occurs of safe working practices are compromised. 4. Applicant must apply immediately for emergency works before starting the work. 5. The applicant must provide method statement & risk assessment specifically for the intended works and the site specific conditions reflecting the Qatar Rail interface 6. Any damage, partially or totally, to Qatar Rail assets shall be reported to Qatar Rail immediately. All costs will be at the applicants account. 7. All costs to carry out the intended works (design & construction) are at the applicants account. 8. The Qatar Rail approval of the intended works is for the duration of the works as specified in this permit for the specified duration. 9. If the intended work of the applicant requires more than the specified duration, a new Permit to Work shall be submitted WITH reasons for extension. 10. Any change to the reviewed documents or design or method of work is required to be notified to Qatar Rail immediately and renders this document as invalid. A new application has to be submitted. 11. The applicant shall comply with the law, rules, standards and regulations of the State of Qatar as well as Qatar Rail & Operational rules & regulations & guidelines. 12. Qatar Rail reserves the right to carry out site inspections announced and unannounced. Access shall be granted to Qatar Rail representatives. 13. The approved permit shall be available on site at all time and readily available to Qatar Rail on request. Work Execution (SITE TO BE SAFE AT ALL TIMES) First Option – Work during non-revenue hours of the railway (engineering hours, night time) – most preferred Second Option – Work to be carried out in parts or half-half (to allow traffic-and pedestrian-movement) If work cannot be completed at vehicular- and pedestrian crossing location(s) make safe & install steel plates over the excavation temporary. Work Completion 1. As-built drawings and relevant quality & supporting (photographs) documentation to be submitted to Qatar Rail. 2. On completion of work Qatar Rail must be notified and respective Qatar Rail assets to be formally handed over. Process for Emergency In genuine case of emergency one can obtain the emergency RO permit offline by informing the concern MOI Traffic Police Engineers as mentioned below table. MOI Eng Name Zones Mobile Hytham Alawad 51, 52, 53, 54, 55, 56, 57, 58 66439220 Adel Al Mesri 70, 71, 72, 73, 74, 75, 76, 77, 78, 79 55508722 Zuhair Albarbari 28, 29, 48, 49, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98 55989613 Siddig Dali 2, 12, 20, 21, 31, 32, 33, 34, 35, 36, 37, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69 55942482 Amar Ali 1, 3, 4, 5, 6, 7, 13, 14, 15, 16, 17, 18, 19, 22, 23, 24, 25, 26, 27, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 50 66282048 In addition, an email must be sent to the following email addresses for their information: Name Position Email Phone Rizwan Malek ROMD QPRO Admin, Roads Inspector - 3 [email protected] +974 - 44527340 Mohammad Abdelaaty QR QPRO Admin, Sr. Infrastructure Engineer [email protected] & [email protected] +974 - 44331751 Markus Leppert QR QPRO Admin, Sr. Interface Manager [email protected] & [email protected] +974 - 44331579 Ashwin Rabadia Land Parcel Developments (PIN), Interface Manager [email protected] & [email protected] +974 - 44331242 For an offline Emergency RO, the applicant has to confirm that the RO belongs to the following condition: • Defect potentially causing injury or damage to a person or property • Defect causing a traffic accident • Defect affecting traffic movement MOI Traffic Safety Department (TSD) Guidelines for Emergency Road Opening Permit (RO4) 1. Emergency works are those that must be addressed immediately and directly affect the wellbeing and livelihood of the public or general traffic. 2. Typical emergencies include: Collapse of soil or structures or severe deformation of pavement; Excessive leakage of potable or foul water; Power and water outages and such, Any other safety concerns that affect traffic such as debris on main traffic thruway; Any other issues that has a direct impact on wellbeing and livelihood of public 3. Cases that are not considered emergencies by TSD are those where work can be postponed without direct impact to public wellbeing such as: Gully cleaning, CCTV maintenance, Painting and street sweeping, Loading of materials, Street lighting maintenance, Trial pits, any other works not affecting public safety etc. Proof of Emergency The applicant authority must provide proof of the emergency. LEADING EXCELLENCE │CMS Ref.: TM-215-F25, 01/04/20, Rev. 1.0 Page 2 of 3 Qatar Rail QR-PERMIT Ref. # Permit to Work ____________________ Third Party Emergency Work (Filled out by Qatar Rail) Company Management System PERMIT ACTIVATION - ACKNOWLEDGE – CLOSING Contacts & STATION MASTER LIST SERVICE PROVIDER (O&M) DOHA METRO & LUSAIL LRT (TRAMS) Building 14 in Ras Bu Fontas Depot Mr. Amit CHAKRABORTY, Civil Interface Mgr (3001 8117) RKH-Qitarat [email protected] GENERAL STATION MASTER GSM Mobile 30263011 RED LINE STATION CONTACTS GREEN LINE STATION CONTACTS # Station Mobile Email # Station Mobile Email 1 Al Wakra(WAK) 31592001 [email protected] 1 Al Riffa (RIF) 31592019 [email protected] 2 Ras Bu Fontas (RBF) 31592002 [email protected] 2 Education City (EDU) 31592020 [email protected] 3 Economic Zone / Freezone 31592003 [email protected] 3 Qatar National Library 31592021 qatar.national- (ECZ) (QNL) [email protected] 4 Oqba Ibn Nafie (OIN) 31592004 [email protected] 4 Al Shaqab (SHA) 31592022 [email protected] 5 Al Matar Al Qadeem 31592005 [email protected] 5 Al Rayyan Al Qadeem 31592023 alrayyan.alqadeem@rkhqitarat (MAQ) (RAQ) .com 6 Umm Ghuwailina (UMG) 31592006 [email protected] 6 Al Messila (MES) 31592024 [email protected] 7 Al Doha Al Jadeda (DAJ) 31592007 [email protected] 7 Hamad Hospital (HAH) 31592025 [email protected] 8 Msheireb (MHB) 31592008 [email protected] 8 The White Palace (TWP) 31592026 [email protected] 9 Al Bidda (BID) 31592009 [email protected] 9 Al Mansoura
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