GENERAL WORK PERMIT

This permit is valid only for the period stated at ‘Part 1’ of this permit. The conditions of issue must be
complied with throughout the duration of work. This permit may be withdrawn at any time. You are
responsible for the copy of this permit to be produced upon request on site.

GENERAL WORK SHOULD NOT COMMENCE UNTIL PART 1 TO 5 ARE COMPLETED

PART 1: APPLICATION - To be completed by sub-contractor/
PERMIT NO: PTWOP-
supervisor in-charge
Work Performed By (Company) Natural cool air conditioning &
Engineering Pte Ltd
Name of Supervisor In-Charge
SOUNDERRAJAN
Work Location/Area Level 1,2,3,4 NLB AHU

Duration (Date / Time) From 29/01/2024 To 10/02/2024

8;30am to 5;30pm
Description of Work Replace new EAC black face
(Please enclose
plate cell at NLB AHU
drawing/ sketch as
necessary)

Requested By
Date / Time 22/01/2024
(Name/Contact No.) SOUNDERRAJAN/83672763 02:00pm
PART 2: ENDORSEMENT BY SUB CON SAFETY PERSONNEL
Safety & Health Measures Tick Safety & Health Measures Tick
Environment aspects
1. I have evaluated the Provision of adequate PPE
eliminated
hazardsand risks
associated with the Provision of signage and Adequate ventilation (If
job. barricade required)
Sufficient Lighting (If Provision of proper access way
2. Hazards and required) (If required)
risks are Work personnel briefed on Have you confirmed that no
eliminated or risk- impact assessment of other existing permits present
criticallyreduce the work scope possible hazards to this job?
and all Reasonably practicable
Is PPE adequate and measures have been taken to
recommended safeguard the safety and
safety &health appropriate for this job as
indicated by permit health of work personnel and
measures are in applicant? preservation of the
place. environment
Work area is safe.
Environmental impacts
eliminated

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 3. There are no
incompatiblework Above Safety, Health and Environmental checks conducted
processes being
carried out.
SOUNDER RAJAN / Natural Cool / Project engineer
4. I have verified
that the Safety
and Health Work
Practices and by: (Name / Company / Designation / Signature) Date / Time
Risk Assessment
have been 24/01/2024/06:00pm
briefed
PART 2B: EVALUATION BY WSH OFFICER/ SAFETY ASSESSOR

1. The necessary safety measures are in place prior to the start of the General work.

2. Safety and Health briefing and Risk Assessment Report was briefed.

Name : SOUNDERRAJAN Signature :

Designation : WSHO / Safety Assessor Date / Time : 224/01/2024/06:00pm

Remarks :

PART 3: APPROVAL - INTER-AGENCY PLANNING & OPS GROUP (IPOG)

*APPROVED / NOT APPROVED * Delete where necessary

Name : Signature :

Designation : Date / Time :

Remarks :

PART 4: ACKNOWLEDGEMENT AND APPROVAL BY CBM

1. I acknowledge and approve that the above-mentioned works are being carried out.

Name : Company :

Designation : Date / Time :

Signature :

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PART 5 – SAFETY AND HEALTH BRIEFING RECORD
ATTENDANCE RECORD
S/No. Name Sign S/No. Name Sign
1 SOUNDERRAJAN 6 Mohamad Daud

2 Zulkarnain 7 Nasarudin

3 Yap Chen Heong 8 Qin MingLei

4 Pang Pung Liang 9 ViCha Al Som Chit

5 Liau Chei Heng 10 Azlan Bin Mohamad Daud

PART 6A: CLOSURE OF PERMIT-TO-WORK (By Applicant)

I hereby inform the IPOG/CBM that the above work has completed on
(Date / Time). I confirmed that the work area / public area has been cleared up with no obstruction to
accesses and all safety and health precautions has been put back in.

Name : SOUNDERRAJAN Company : NATURALCOOL

Designation : SITE ENGINEER Date / Time : 24/01/2024/06:0

Signature :

PART 6B: REVOKATION OF PERMIT by Site Authorized IPOG/ CBM Only

Name : Signature :

Designation : Date / Time :

Reason for Revocation

Tick (√) accordingly

Action Taken
Yes No
1. Is it a first-time offence?
2. Issue WSH Instruction or Fines before?
3. Issue STOP Work Order Before?

Note : (1) Upon revoke of PTW, it is required to record in the CAPA form prior to take action.
(2) To Resume rectification work of high rick activity, application of new PTW is required.
(3) To resume high risk activity, new PTW application is required.

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