‫شركة مليته للنفط و للغاز – فرع ليبيا‬

‫نموذج إدارة الرحلتا حقل الوفاء‬

MELLITAH GAS BV LIBYA WAFA FIELD JOURNEY MANAGEMENT FORM
TO BE COMPLETED BEFORE EVERY JOURNEY WHEN LEAVING WAFA BOUNDARIES
‫إستعمـــال هذا النمــوذج عنــدمــا تكـــون الرحـــــلة خــارج حـــدود الحقــــــــــل‬
Date issued: ……/8/…2019………. .………………………………………………………………………. job No………………….
GENERAL INFORMATION ‫معلوماتا عامة‬
PROCEDURE:
 Must be checked and signed by the HSE Supervisor and Security Supervisor after being signed by applicant
 Endorsed by Field Manager
 In accordance with Wafa Specific Driving Policy, all drivers must ensure that they are licensed and authorized to drive
in accordance with Libyan Laws
 The applicant must close/renew this permit before or on date of expiry
 All items issued by HSE must be returned to HSE upon journey completion in same condition as received from HSE, if
not used.
 Desert pass for all and vehicle registration
 Radio / Thuraya Phone must be provided before leaving the field
SAFETY CHECK LIST YES NO REMARKS
1. Sufficient fuel for journey and return
2. Sufficient water for all personnel
3. Spare wheel
4. Battery jump leads
5. Shovel and other rescue equipment
6. First Aid Kit
7. Fire Extinguisher in good condition.
Contact No:
8. Fixed or mobile radio or Thurya Phone

Journey route From Zentan City …………………. To ‫…………… والى‬Wafa………………….. ‫الرحلة من‬
Vehicle Type and colour:…Toyota hilux …(White)….. ……… ‫نوع وسيلة المواصلتا واللون‬
Vehicle Registrations No : : ‫رقم اللوحة‬
Journey Reason: Change work rotation ‫الغرض من الرحلة‬
I UNDER STAND ALL THE ABOVE POINTS AND HSE REQUIREMENTS FOR THIS JOURNEY
DRIVER NAME: ‫محمد الشعاب‬Job Title: ‫سائق‬ ‫المهنة‬ ‫اسم السائق‬
Passenger Name ‫أسم الراكب‬ Job Title ‫المهنة‬
‫عادل عكاشه‬
‫عمر شلوف‬
RADIO/THURAYA PHONE NO: Emergency Contact Details

DEPATURE TIME DATE 17./8/ 2019 ‫ التاريخ‬............................. ‫وقتا المغادرة‬

ESTIMATED TIME RETURN DATE …../…/ 2019 ‫وقتا الرجوغ‬..………………… ..‫التاريخ‬
HEAVY VEHICLE WORK SHOP
I HAVE CHECKED THE FOLLOWING YES NO
Tire wheel, brakes, oil, water motor, jack, tools, indicators, lights, fuel.
‫الوقود‬,‫النوار‬,‫الموشراتا الجانبية‬, ‫رافع العجلتا وملحقاته‬, ‫زيتا ومياه المحرك‬,‫ الفرامل‬,‫ الطاراتا‬:‫قد تم فحص العربة كالتي‬
Workshop Supervisor: Name……………………….. …………………………Signature………………..
Comments:………………………………………………………………………………………………………
Security Supervisor Name…………………….. ………………………. Signature………………………................

HSE Supervisor/Journey Manager……………................................ Signature ……………………................

Dept. SPT/Coord ……………………………………………………….. Signature………………………………..

Approved by Field Manager …………………………… ……………… Signature …………………………………..

Journey closed date……../……/ ………………Time…...:………………………..Signature…………………………..

Name ………………………………………………………..Job title…………………Department………………………...

HSE Supervisor/Journey manager name……………………………………… Signature……………………………

Remarks:……………………………………………………………………………………………………………………………
NOTE: COPY MUST BE RETURINER WITH TRIP LEADER.