PERMIT TO WORK

PTW No: 0204238

NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY

SECTION 1 - REQUISITION HOT WORK CERTIFICATE CONFINED SPACE ENTRY CERTIFICATE

Applicant's Name: M Farid Amin Mohamad Department/Company: PETRONAS Gas Berhad AREA CLASSIFICATIONS CONDITIONS TO BE IMPLEMENTED BY RECEIVING AUTHORITY / WORK LEADER
Nalawi Safe Zone 2
Staff No/IC No: 1064787 Location/Facility: GPK-GPP4
Equipment No: Q4-711A Area: WATER SYSTEM Vehicle Entry Into The Operating Unit Fire Extinguisher S.No Name
Spark Arrestor
Work Description: Planned Start Date: 11 Jun 2023 Locate Spark producing equipment
GPP4-MMSSB-Q4-711A- Vehicle entry for forklift to loading/unloading activity (VE CERT will be attach Expected End Date: 17 Jun 2023 away from sewer/trench/pipe rack
later) Cover Sewer/Drain/Sump I have personally checked that all control measures to prevent release of hazard have
been put in place

S.No Name Combustible

RA Name: Mohd Afandi B Ahmad Before Work Start
SECTION 2 - HAZARDS/HAZARDOUS ACTIVITIES After Break
Toxic
Falling Noise Ergonomic Hand Tools Rotating Equipment Before Work Start
Loading/Unloading
After Break
Others: Every 4 Hours
SECTION 3: PERSONAL PROTECTION EQUIPMENT Oxygen
Before Work Start
Other Specify: Please Gen purpose gloves After Break
Safety Glass follow JHA and HSE Dust Mask/ Pre-filter Ear muff Cotton Gloves Every 4 Hours
Safety Helmet requirement (N95) Ear plugs
Coverall Special precautions: Follow JHA & safety requirements
Other Specify: Please
follow JHA and HSE This permit is approved provided the above conditions and precautions are
requirement implemented

Safety Shoes/Boot Seat Belt APPROVING AUTHORITY APPROVING AUTHORITY

Other Specify: Please
follow JHA and HSE Name: Syamsul Anuar B M Sidik Name:
requirement Department: Gas Processing Designation: Department: Designation:
Special Precautions: Kerteh Date:
Date: 09 Jun 2023
SECTION 4 – SUPPORTING CERTIFICATES / DOCUMENT GAS TEST RESULTS
Vehicle Entry Certificate Job Hazard Analysis Tests Standard for CSE Standard for Non- Initial result
VE CERT 0015879 Work CSE Work
0018714 AGT Name: Sy Izlan Sy Ahmad Radzi   Date: 11/06/2023
Oxygen 20% - 20.9% 20% - 20.9% 20.9 (GPU/PGB)
SECTION 5 - WORKSITE PREPARATION / PRECAUTIONS Flammable < 1% LEL < 10% LEL 0 Time: 8:23 AM
Gases
Barricade & Place Warning Sign Notify Surrounding Parties HS < 50% PEL < PEL 0
Secure Tools/ Materials Against Falling Available Tagging
Contact Area/ Panel Operator/ PGCC Before Work Start Others: Follow JHA CO < 50% PEL < PEL 0
Contact Area/ Panel Operator/ PGCC On Completion
Available Tagging VOC < 50% PEL < PEL 0
Cover Sewer/ Drain/ Sump SECTION 7 – PERMIT REVALIDATION
Fire Blanket (Note: This PTW form can be used for a maximum of 7 days, subject to daily revalidation by each shift . Nevertheless, for confined space entry it is only valid for 12 hours per
Fire Extinguisher day)
Locate Spark Producing Equipment Away From Sewer/ Trench/
Pipe/ Rack RA/RAR AA Return By RA/RAR Acknowledge By AA/AAR
Remove Combustible Material Date
Remove Flammable Material Day Shift Night Shift Day Shift Night Shift Day Shift Night Shift Day Shift Night Shift
Spark Arrestor 11/06/2023
Availability of Signalman / Traffic Controller
SECTION 6 – JOINT SITE VISIT BEFORE WORK START / APPROVAL 12/06/2023
I have personally checked the area and equipment to be worked on and am satisfied the work requested can be carried out safely. 13/06/2023
14/06/2023
Name: Name: 15/06/2023
Designation: Designation:
16/06/2023
A G R EED B Y R EC EIVIN G A U T H O R IT Y A PPR O VED B Y A PPR O VIN G A U T H O R IT Y A G R EED B Y W O R K L EA D ER
17/06/2023
Name: M Farid Amin Mohamad Name: Low Wei Jin (GPU/PGB) Name: Fadil SECTION 8 – HAND BACK
Nalawi Date: 11 Jun 2023 Time: 8:38 am Signature:
Date: 11 Jun 2023 Time: 8:26 am Company/ Dept.: RECEIVING AUTHORITY APPROVING AUTHORITY
Date: Time:
Name: Name:
Date: Time: Date: Time:
STOP WORK AND EVACUATE AREA ON HEARING ALARM
THIS IS A COMPUTER-GENERATED DOCUMENT. NO SIGNATURE IS REQUIRED. PLEASE ENSURE THIS PERMIT IS DISPLAYED AT WORK SITE
 GAS TEST RESULTS
Date Time Oxygen Flammable H2S CO VOC AGT Name Remarks
Gas

11/06/2023 08:23 20.9 0 0 0 0 Sy Izlan Sy Ahmad Radzi (GPU/PGB)