CMS 01 – Scope of Work

ONE SCOPE OF WORK PER JOB / AREA

Company Name

Order/Vendor Number

Short description of services to be rendered

Area / areas where work will be done

Boundaries

Energy Sources and Hazards Identified

Detailed scope of work

EHS-G000-TEM-0016 REVISION 00 Page 1 of 2

ISSUED: 15 April 2019

 CMS 01 – Scope of Work

Attach any additional information regarding the scope of work (i.e. drawings, etc.).

Agreement to Scope of Work

On behalf of the Contractor Company, I fully understand the Scope of Work and make it my responsibility
to ensure that all persons under my supervision are competent to deal with the above hazards and
associated risks. In the event of anything being unclear I shall be obliged to seek guidance for enhanced
clarity.

The Contractor Company will attach a detailed and signed risk assessment to this document that
describes the controls that shall be adopted to eliminate, control or minimize the above mentioned hazards
and associated risks.

EHS-G000-TEM-0016 REVISION 00 Page 2 of 2

ISSUED: 15 April 2019