PERMIT TO WORK

PTW No: 0204237

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 Pickup to loading/unloading (VE CERT will be attach later) Expected End Date: 17 Jun 2023 away from sewer/trench/pipe rack
Cover Sewer/Drain/Sump I have personally checked that all control measures to prevent release of hazard have
been put in place
RA Name: Mohd Afandi B Ahmad Combustible
S.No Name Before Work Start
SECTION 2 - HAZARDS/HAZARDOUS ACTIVITIES
After Break
Noise Ergonomic Hand Tools Loading/Unloading Every 4 Hours
Others: Toxic
SECTION 3: PERSONAL PROTECTION EQUIPMENT Before Work Start
After Break
Every 4 Hours
Other Specify: Please Gen purpose gloves Oxygen
Safety Glass follow JHA and HSE Dust Mask/ Pre-filter Ear plugs Cotton Gloves Before Work Start
Safety Helmet requirement (N95)
Coverall Safety Shoes/Boot After Break
Other Specify: Please Every 4 Hours
follow JHA and HSE Seat Belt
requirement Other Specify: Please Special precautions: Follow JHA & safety requirements
follow JHA and HSE
requirement This permit is approved provided the above conditions and precautions are
Special Precautions: implemented
APPROVING AUTHORITY APPROVING AUTHORITY
SECTION 4 – SUPPORTING CERTIFICATES / DOCUMENT
Job Hazard Analysis Vehicle Entry Certificate Name: Syamsul Anuar B M Sidik Name:
0015879 VE CERT Department: Gas Processing Designation: Department: Designation:
0018714 Kerteh Date:
Date: 09 Jun 2023
SECTION 5 - WORKSITE PREPARATION / PRECAUTIONS
GAS TEST RESULTS
Barricade & Place Warning Sign Notify Surrounding Parties Tests Standard for CSE Standard for Non- Initial result
Secure Tools/ Materials Against Falling Available Tagging Work CSE Work
Contact Area/ Panel Operator/ PGCC Before Work Start Others: Follow JHA AGT Name: Sy Izlan Sy Ahmad Radzi   Date: 11/06/2023
Oxygen 20% - 20.9% 20% - 20.9% 20.9 (GPU/PGB)
Contact Area/ Panel Operator/ PGCC On Completion
Available Tagging Flammable < 1% LEL < 10% LEL 0 Time: 8:22 AM
Cover Sewer/ Drain/ Sump Gases
Fire Blanket HS < 50% PEL < PEL 0
Fire Extinguisher
Locate Spark Producing Equipment Away From Sewer/ Trench/ CO < 50% PEL < PEL 0
Pipe/ Rack
Remove Combustible Material VOC < 50% PEL < PEL 0
Remove Flammable Material
Spark Arrestor SECTION 7 – PERMIT REVALIDATION
Availability of Signalman / Traffic Controller (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
day)
SECTION 6 – JOINT SITE VISIT BEFORE WORK START / APPROVAL RA/RAR AA Return By RA/RAR Acknowledge By AA/AAR
I have personally checked the area and equipment to be worked on and am satisfied the work requested can be carried out safely. Date
Day Shift Night Shift Day Shift Night Shift Day Shift Night Shift Day Shift Night Shift
11/06/2023
Name: Name:
Designation: Designation: 12/06/2023
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 13/06/2023
14/06/2023
Name: M Farid Amin Mohamad Name: Low Wei Jin (GPU/PGB) Name: Fadil
Nalawi 15/06/2023
Date: 11 Jun 2023 Time: 8:38 am Signature:
Date: 11 Jun 2023 Time: 8:25 am Company/ Dept.: 16/06/2023
Date: Time: 17/06/2023
SECTION 8 – HAND BACK

RECEIVING AUTHORITY APPROVING AUTHORITY

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 08:22 20.9 0 0 0 0 Sy Izlan Sy Ahmad Radzi (GPU/PGB)