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Environmental conditions in Sultanate of Oman and other Arabian Gulf countries are some of the harshest in the world. Primary Aluminium smelting requires enormous amounts of energy, in the form of affordable and uninterrupted supply of electricity. Workers engaged in physically demanding and manual tasks in hot environments are vulnerable to heat illness, besides being at risk being easily fatigued leading to work place injuries.Combination of work place and physiological monitoring procedures incorporated into a structured Heat Stress Monitoring Program implemented by the Medical Team headed by the main author supported by and in collaboration with external consultant(co-author) have lead to discernible and sustainable occupational health improvements in the work placeWhile work place monitoring requires measuring relevant thermal index that is easy to measure and interpret on the spot, physiological monitoring involves measurement of parameters like urine specific gravity, heart rate and body temperature etc by a licensed healthcare professional at work place. Major challenge however is how to effectively communicate the work place risks, results of measurements mentioned earlier and preventative and remedial measures to the work force, in order to translate the concepts into effective occupational health intervention. Communicating with workers needs to be void of technical jargon and keeping that in mind, Sohar Aluminium Medial Team introduced a revised Heat Stress Management Program incorporating work site Hydration Monitoring procedures and communication strategy. The idea or concept of ‘issuing cards on the spot’ used in football game to educate and discipline the players was incorporated into Heat Stress Management program, along with Traffic signalling colour codes. Hydration tested workers were classified into three classes as ‘Normally Hydrated (with USG<1.019), ‘Under Hydrated (with USG 1.020–1.029) and ‘Dehydrated’ with urine specific gravity results tested with a refractometer. Normally hydrated workers were given a green card, Under hydrated workers a yellow card and Dehydrated workers a Red Card, with relevant messages explaining the result of testing and measures needed to be taken by the workers.This proactive approach in the program lead to effectively prevent and mitigate heat stress at Sohar Aluminium and made a major and significant difference to the workers and contractors and helped in reducing the incidence of heat illnesses.Results of urine specific gravity testing were analysed daily, weekly and monthly and shared with relevant leaders in management as well. Work place measurements of thermal index parameters like temperature, humidity etc. were analysed which helped in creation of ‘Heat Stress Risk Map’ for specific work areas and the entire organisation. These measures helped area managers to plan work activities prudently during summer months. Statistical Analyses results on the number of green cards, yellow cards and red cards were incorporated into management lean Board discussions.These measures among other supportive measures resulted in significant reduction of cases of heat illness, particularly elimination of recordable heat illness cases from 2013 through 2016 (figures 1 and 2).