CMS 25 - PERMISSION TO USE OPERATION / PROJECT EQUIPMENT

Company Name

Contractor Supervisor

Date

Instruction:

This document shall only be completed if the contractor needs to use any tools / equipment or machinery provided by the
Client.

Authorisation is herewith provided to the above-mentioned contractor, through its Supervisor,

Mr__________________________ indicated above, for the use of the below specified
equipment/machinery/articles/substances in the performance work regulated by the contract between _____________
Operation / Project and the contractor. The Contractor Manager herewith takes note of the fact that the below listed
equipment/machinery/articles/substances are to used in accordance with not only legislative requirements, but also Operation
/ Project Standards of Health and Safety, and undertakes to ensure that the legislative and Operation / Project standards will
be adhered to. The Contractor is responsible for the maintenance, inspection and safekeeping of the equipment during use.

Serial Work to be Duration of Date Received Back

Description of equipment
number performed authorisation In Good Order

The Contractor Manager herewith accepts responsibility for the above listed articles, and the safe use thereof. If uncertainty
exists regarding the correct use of the above listed articles, it is the responsibility of the contractor to bring this to the attention
of the Operation / Project KIO Contractor Manager, before use is made of the listed articles.

Title: Responsible Engineer Contractor Manager

Name and Surname

Signed

Date

EHS-G000-TEM-0014 REVISION 00 Page 1 of 1

ISSUED: 15 April 2019