HEALTH & SAFETY

MANAGEMENT SYSTEM
PERMIT TO WORK Page 1 of 2
HSE –FORM NO.-REV.002

PROJECT: SERUNI RESIDENCE ENJ/HSE/F/

Ref. No. PTW/NTMS/05

Permit To Work Date -Time
Start Finish
SPECIFIC TASK: FIRE FIGHTING

Person In Charge of Work Contact No.

NURAZLI BIN SADLI
Requested by:
Supervisor SALIM ALI 018-6146639

Position Engineer
AZLI 011-6659069
SITE SUPERVISOR
Contractor Name HSE Officer
NATAMAS SDN.BHD
Competent
Date Request
Person

Location / Area / KM Others:

L35 (Z1&Z2), L17 (Z3&Z5), L5 (LIFT LOBBY&PARKING), LV

Total No. of Workers
6,7,8 (Z1&Z3).L29,30,31 & 32
(To provide and update namelist) 7
]

1.0 Description of work

- LEVEL 40 (Z1&Z2), LEVEL 22 (Z3&Z5) – INSTALLATION PIPE SLEEVE (WET RISER,HOSEREEL&FIRE ALARM
-LEVEL 5 – INSTALLATION PRESURIZE SYSTEM (ROD)
-LEVEL 8,9&10 – INSTALLATION PIPE WET RISER AT STAIRCASE AFTER SKIM DONE
-LEVEL 33,34,325(Z1&Z2) – INSTALLATION CONDUTE AND WIRING FOR FIRE ALARM

1.2 Job Safety Analysis / Safety Method Statement for the task available?

Remark:

2.0 Machinery and Equipment to be used ? Total No. of Machinery 4

- GRINDER
- HAND DRILLING
- WELDING

- CUTTING
 HEALTH & SAFETY
MANAGEMENT SYSTEM
PERMIT TO WORK Page 2 of 2
HSE –FORM NO.-REV.002

PROJECT: SERUNI RESIDENCE ENJ/HSE/F/

3.0 Proposed Safety Precaution to be implemented:

Elimination / Substitution Isolation Engineering Control Administrative Control / PPE
Remarks :
-AS PER HIGHLIGHTED IN METHOD STATEMENT AND HIRARC

4.0 Comments by E&J HSE Officer:

Note : This “Permit To Work” (PTW) form

shall be submitted to E&J HSE Officer for
approval within 24 hours before start work.
This PTW is valid for a working period
herein stated in this permit . If the
extension of working period is required,
please request for new PTW.
Requested, checking, evaluation by Review and Endorsement of Work By Final review Assessment by E&J Safety
Contractor: E&J Project Team: Department:

Name : AZLI Name:

Position: ENGINEER Name: Position:
Date : Position: Date :
Time : Date Time :
Time::

NOTE: Copies to : Project Manager Other: