Professional Documents
Culture Documents
VT4 PTW Template
VT4 PTW Template
VT4 PTW Template
DMPP Consortium
Attachment 1
HOT WORK PERMIT
Company:
Date:
WELDING
GAS CUTTING
BRAZING
GRINDING
Others
Location:
Section I
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Valid Till
Extended Date
Valid Till
Extended Time
Permit Contents:
Valid Till
1) Permit to Hot Work (Two copies one for site one for EHS file)
2) Method Statement and JSEA (Copy for Site)
3) Personnel Training Record Sheet (To be placed in EHS file)
HOT work permit shall not exceed its duration for more than seven (7) days.
Work Permit shall be renewed on the Eighth (7th) day WITHOUT FAIL
Section III
PREREQUISITE
for YES and X for No
NA
Adequate Earthing
Adequate Ventilation
Adequate illumination
Area barricaded
Yes/
No
NA
Company Name:
have checked the location and the welder has been briefed about the emergency
Nature of Job: .
procedure and a toolbox talk given on using the fire extinguisher to ALL involved
Tel.No
in the activity.
Email
Date: // Name; . Signature;
Rev. C
Page 4 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected from
the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 5 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 2
PERMIT TO EXCAVATE
Company:
Date:
Excavation
LOCATION:
DETAILS OF THE PERMIT RECEIVER (SC = Sub Contractor, DHI = DOOSAN)
Task Supervisor/Foreman(SC)
Contact Number
Contact Number
Contact Number
PERMIT VALIDATIONS
Date ____________________
Time ________________
PREREQUISITE
Yes/No
NA
Have The Operatives for the task been briefed on the Risk
Assessment. Is this Signed for?
(Work May not commence if one of the following is not complied with)
8
Planned Equipment For
Excavation
Yes/No
Allowed / Disallowed
PTW CANCELLED:
Rev. C
By:
Page 6 of 29
NA
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV
Comments.
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected from
the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 7 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 3
CRANE OPERATING PERMIT
Company:
Date:
Crane Operation
LOCATION:
DETAILS OF THE PERMIT RECEIVER (SC = Sub Contractor, DHI = DOOSAN)
Task Supervisor/Foreman(SC)
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Valid Till
Extended Date
Valid Till
Valid Till
Extended Time
Section III
PREREQUISITE
for YES and X for No
NA
Lifting procedure/prepared/planned?
Shackles inspected?
Crane :
Type :
Model No. :
Yes/No
NA
Vehicle No.:
Company Name:
have checked the location and the welder has been briefed about the
Nature of Job: .
emergency procedure and a toolbox talk given on using the fire extinguisher to
Tel.No
Rev. C
Page 8 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV
PERMIT APPROVAL
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times
during work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
disconnected from the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture
Manager
Doosan Electrical/
Mechanical Manager
Subcontractor Area
Manger
Doosan QA/ QC
Manager
)
Rev. C
Page 9 of 29
Security
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 4
ELECTRICAL WORK PERMIT
Company:
Date:
Description of
Work
Electrical Work
LOCATION:
Section I
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Valid Till
Extended Date
Valid Till
Extended Time
Valid Till
Section III
PREREQUISITE
Drill
Breaker
Others
Industrial Sockets
(Blue) in use
Armoured cable
D
3
4
5
Manufacture
Serial
Number
Electricians Declaration
I_________________ representing _________________ hereby declare that I have checked the
location/machine mentioned above and confirm that it is in line with all safety requirements and is
safe to be used.
F
G
H
I
J
Yes
NA
PERMIT APPROVAL
Rev. C
Page 10 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times
during work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
disconnected from the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date
/.../..
Comments
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 11 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 5
NIGHT WORK/ HOLIDAY WORK PERMIT
Company:
Date:
Description of
Work
Night Work
Holiday Work
LOCATION:
Task
Supervisor/Foreman(SC)
Contact Number
Contact Number
Contact Number
PERMIT VALIDATIONS
Date ____________________
Time ________________
Date ____________________
Time ________________
IN CASE OF NIGHT WORK PERMIT, THE PERMIT SHOULD BE SUBMITTED AND DISCUSSED BEFORE 4 PM. ALL REQUIRED
SAFETY WORK PREPARATION BEFORE 5 PM and IT HAS TO BE CONFIRMED WITH Doosan EHS MANAGER.
IN CASE OF HOLIDAY WORK, THE PERMIT SHOULD BE SUBMITTED AND DISCUSSED AT LEAST ONE DAY BEFORE.
Section III
PREREQUISITE
for YES and X for No
NA
Attended Briefing
Details of Employees
working in the night/ holiday
Name, Company
8
Planned Equipment For Night
Work/ Holiday Work
Allowed / Disallowed
NA
Yes/No
PTW CANCELLED:
Rev. C
By:
Page 12 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV
PERMIT APPROVAL
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times
during work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
disconnected from the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 13 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 6
CONFINED SPACE ENTRY PERMIT
Company:
Date:
PAINTING
FINISHING
HOT WORKS
Others (Specify) ..
Location(s) :
Section I
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date ____________________
Time ________________
NO EXTENSION WILL BE
PREREQUISITE
for YES and X for No
NA
Watcher(s) required?
Yes/
No
NA
PERMIT APPROVAL
Rev. C
Page 14 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section V
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times
during work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
disconnected from the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date
/.../..
Comments
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 15 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 7
IONIZING RADIATION WORK PERMIT
Company:
Date:
Location(s)
Section I
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date ____________________
Time ________________
NO EXTENSION WILL BE
PREREQUISITE
for YES and X for No
NA
Yes/
No
NA
(kv)
curies
PERMIT APPROVAL
Rev. C
Page 16 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times
during work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
disconnected from the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 17 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 8
WORKING OVER WATER (MARINE) WORK PERMIT
Company:
Date:
Location(s)
Section I
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date ____________________
Time ________________
NO EXTENSION WILL BE
GIVEN ON THIS PERMIT
PREREQUISITE
for YES and X for No
NA
H
B Wind/Waves checked?
C Visibility checked?
Yes/
No
NA
Special Note.
Section IV
PERMIT APPROVAL
Rev. C
Page 18 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times
during work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
disconnected from the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 19 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 9
DIVING WORK PERMIT
Company:
Date:
Location(s)
Section I
Contact Number
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date ____________________
Time ________________
PREREQUISITE
for YES and X for No
NO EXTENSION WILL BE
GIVEN ON THIS PERMIT
NA
B Wind/Waves checked?
Yes/
No
NA
Special Note.
Section IV
PERMIT APPROVAL
Rev. C
Page 20 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times
during work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
disconnected from the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 21 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 10
Date:
Description of Work
Location:
Section I
Task
Supervisor/Foreman(SC)
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Section III
Valid Till
PREREQUISITE
Yes/No
NA
F
Yes/No
NA
- All grating must be re-installed at the completion of the work task or the end of the shift. No opening shall remain beyond
the end of the shift, unless a new permit is obtained.
Tt c tm sng st phi c lp t li khi hon thnh cng vic hoc cui mi ca lm vic. Khng c tho d cc
tm sn thp nhng khu vc khng c giy php vo cui ca lm vic.
- No opening shall ever be left unguarded. post a hole watch if necessary.
Khng mt l hng no c b st m khng c che chn. Nu cn thit, dng hng ro cnh bo.
- Ensure hooking strap are provided and fitted properly when removing / installing grating.
m bo dy buc cn thn khi tho g gin thao tc/ lp t sn thao tc.
Rev. C
Page 22 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Company Name:
understand the work which is to be carried out and the method of work to be
Nature of Job: .
Tel.No
Email
PERMIT APPROVAL
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected from
the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture Manager
Doosan Electrical/
Mechanical Manager
Doosan QA/ QC
Manager
Subcontractor
Site Manager
Subcontractor Area
Manger
Security
Rev. C
Page 23 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 11
Date:
Description of Work
Location:
Section I
Task
Supervisor/Foreman(SC)
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Valid Till
Section III
PREREQUISITE
NA
Yes/No
Company Name:
understand the work which is to be carried out and the method of work to be
Nature of Job: .
Tel.No
Email
PERMIT APPROVAL
Rev. C
Page 24 of 29
NA
EVN GENCO3/VTTPMB
DMPP Consortium
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected from
the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture Manager
Doosan Electrical/
Mechanical Manager
Doosan QA/ QC
Manager
Subcontractor
Site Manager
Subcontractor Area
Manger
Security
Rev. C
Page 25 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 12
Date:
Description of Work
Location(s):
Hot Work
Authorizations
Section I
Confined Space
Others
Task
Supervisor/Foreman(SC)
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time issued
Valid Till
Section III
Approval
Isolation (No.)
Section IV
Hazard Condition
Comments
Section V
Hearing Protection
Face Shield
Fall protection
Flash suit
Gas Tester
Respiration(Type)
Gloves(Type)
Other:
Declaration by the Permit Receiver
Company Name:
understand the work which is to be carried out and the method of work to be
Nature of Job: .
Tel.No
Email
PERMIT APPROVAL
Signature
Date .../.../..
Comments
Rev. C
Page 26 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Signature
Date .../.../
Signature:
Date .../.../..
Comments
Section - VII
Name:
Sign:
Date:
Name
Sign:
Date:
Name
Sign
Date:
(Construction Dept./CRE)
All signature verified / Database updated
Work permit controller
Remarks
In case of emergency, please call control room on:___________________________or EHS on: __________________________________
or VT4 First Aid Room on 0623.793.370
Rev. C
Page 27 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Attachment 13
Date:
Description of Work
Hydro Test
Pneumatic Test
Location:
Task
Supervisor/Foreman(SC)
Contact Number
Contact Number
Contact Number
PERMIT VALIDATIONS
Date ____________________
Time ________________
Date ____________________
Permit Contents:
Time ________________
2) Holding Time:
3) Attach Copy of P&ID, Drawing and highlight the area
(Including Watchman Points, Safety Distance)
Section III
PREREQUISITE
for YES and X for No
NA
Yes/No
Allowed / Disallowed
NA
PTW CANCELLED:
Rev. C
By:
Page 28 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times
during work. No equipment shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
disconnected from the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 29 of 29
)
Security