Pre-Printed No: PERMIT TO WORK (COLD WORK ONLY)

0000185
Daily Suspended NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY

SECTION 1: REQUISITION (APPLICANT/RA) SECTION 5: SUPPORTING CERTIFICATES/DOCUMENTS (AS)

APPLIC ANTS NAME: Wan Mohamad Ridhuan Bin ID NO: 951118-03- DATE: 19 Mar AREA C LASIFIC ATION SPEC IAL WORK Cross (X) where applicable
Wan Mohd Rais 6521 2024 (Answer Y/N) INSTRUC TIONS C ONFINED SPAC E ENTRY C ERT. No:______ ROAD OBSTRUC TION/C LOSURE C ERT. No:______
DEPARTMENT/C OMPANY: DIALOG SITE: Bayan Zone 0
DIVING C ERT. No:______ SAFETY SYSTEM BYPASS/OVERRIDE C ERT (NEW). No:______
EQUIPMENT NO: WORK ORDER NO: LIFTING C ERT. No:______ VEHIC LE ENTRY C ERT. No:______
Zone 1
AREA/UNIT: BYDP-D SUB AREA: C ellar Deck LoEAC . No:______ PORTABLE ELEC TRIC AL TEMPORARY INSTALLATION. No:______
Zone 2 JHA. No:JHA 0000185A WORK METHOD STEPS. No:______
Non Hazardous Area EXC AVATION C ERT. No:______ SUPPORTING DOC UMENT. No:______
ELEC TRIC AL ISOLATION C ERT. No:______ WORKING AT HEIGHT C ERT. No:______
Non Hydrocarbon Area PHYSIC AL ISOLATION C ERT. No:______ VENTILATION PLAN. No:______
RADIATION C ERT. No:______ PRESSURISED HABITAT C ERTIFIC ATE. No:______
WORK DESC RIPTION: Manual Handling (Personnel Protection Installation)

SECTION 6: ACKNOWLEDGEMENT REQUIRED AS IDENTIFIED BY APPROVING AUTHORITY (e.g. CSR)

Position
Name
Initial/Date
SECTION 7: AUTHORIZATION
REC EIVING AUTHORITY AUTHORISED SUPERVISOR APPROVING AUTHORITY
Name: Wan Mohamad Ridhuan Bin Wan Mohd Rais Name: Muhammad Hasan Azhari (SKA/Upstream) Name: Rebu Ak Ranggun (SKA/Upstream)
Signature: Submitted Signature: Signature: Approved
Date: 19 Mar 2024 Date: 19 Mar 2024 Date: 19 Mar 2024
Time: 9:46 AM Time: 9:48 AM Time: 9:51 AM

SECTION 8: JOINT SITE VISIT BEFORE WORK COMMENCES (AAR & RA/WL)
I have personally checked the area and equipment to be worked on and I am satisfied that the work requested can be carried out safely (YES/NO). If work cannot proceed give
SECTION 2: HAZARDS/HAZARDOUS ACTIVITIES (APPLICANT &AS) reason why:-
Cross (X) where applicable WORK LEADER APPROVING AUTHORITY REPRESENTATIVE
Battery Operated/ Electronic Device High Traffic Metal Saw/C old C ut Underground Working Name: Wan Mohamad Ridhuan Bin Wan Mohd Rais Name: Ismail Ahmad B (SKA/Upstream)
Electrical Tools Signature: Performed Signature:
Excavation Hot Surface Drilling Scaffolding piping/cables/drains Overboard
C alibration Needle Gun Vehicle Others : Date: 19 Mar 2024 Time: 10:43 AM Date: 19 Mar 2024 Time: 10:41 AM
Gas/Fumes Hydrocarbon Static Electricity
C rane Activities Liquid/Gas Noise Steam Volatile Liquid Note: AS is
Diving Activities Generator/C ompressor Hydro-jetting Pressure Wellhead responsible to
TENORM ensure hazards / SECTION 9: DAILY PERMIT RETURN AND SUSPENSION (WL & AAR) – due to e.g. End of Shift, Stop Work, Drill, Emergency etc
Dust/Powder H2S Lifting Test Toxic Activities
hazardous activities Date/Shift 19/03/2024 19/03/2024 20/03/2024 20/03/2024 21/03/2024 21/03/2024 22/03/2024 22/03/2024 23/03/2024 23/03/2024 24/03/2024 24/03/2024 25/03/2024 25/03/2024
Electricity Hand Tools only Mercury Radiation Substance/C hemical Wireline Activities are identified /Day /Night /Day /Night /Day /Night /Day /Night /Day /Night /Day /Night /Day /Night
Rotating Working at Height adequately WL Sign
Equipment
WL Name
SECTION 3: WORKSITE PREPARATION /PRECAUTIONS (APPLICANT/RA & AS) wmridhu
Cross (X) where applicable Additional Precautions
Area barricade Fire extinguisher on work site Valves chain lock closed Note: AS is responsible to ensure AAR Sign
Bypass Required N2 purged/ventilated Valves chain lock open worksite preparation/ precautions are AAR Name
identified adequately ismail
C learance of escape route Positive Removal of Energy Valves Spading/Blinding
C ontact Area Operator before (EIC ) Warning sign/notice required Due to
work start Positive Removal of Energy Worksite free of combustibles
C ontact Area Operator on (PIC ) Others : Gas test required SECTION 10: DAILY REVALIDATION & ENDORSEMENT (WL, AAR & AA)
completion Scaffold erected and safe to Gas Monitoring
be used Date/Shift 19/03/2024 19/03/2024 20/03/2024 20/03/2024 21/03/2024 21/03/2024 22/03/2024 22/03/2024 23/03/2024 23/03/2024 24/03/2024 24/03/2024 25/03/2024 25/03/2024
Equipment/line blind/spade C ontinuous /Day /Night /Day /Night /Day /Night /Day /Night /Day /Night /Day /Night /Day /Night
Equipment/line drained Secure tools/materials against Every ________ HRS
falling Suspended
Equipment/line removal reason
Site identification (tagging)
AA
Toolbox Meeting Signature
Name
SECTION 4: PERSONAL PROTECTIVE EQUIPMENT (APPLICANT/RA & AS)
Cross (X) where applicable WL
Mandatory Respiratory Eye & Face Fall Protection Hand Protection Personal monitoring Equipment Signature
C overall Protection Protection Fall Arrester C hemical Gloves H2S Meter Name
Airline Set Face Shield Full Body C otton Gloves Personal Distress Unit
Helmet Dust Mask Goggles Harness Impact Glove Personal Dosimeter/Film Badge/Survey AAR
Full Face Welding Mask Body Protection Leather Gloves Meter Signature
Safety Respirator Apron
Glasses Hearing Protection Rubber Gloves Personal O2 Monitor Name
Half Mask Ear Muff C hemical Boot Others
Safety Respirator
Shoes Ear Plug C hemical Suit Life Jacket/Life SECTION 11: HANDBACK & CLOSE (WL, AAR & AA)
Hood Disposable Vest Note: AS is responsible to ensure personal
protective equipment are identified WORK LEADER APPROVING AUTHORITY REPRESENTATIVE APPROVING AUTHORITY
SC BA Suit Seat Belt The above work has been completed YES The All the precautions removed. The worksite is cleaned and The location/equipment may be returned to normal
adequately
Safety glasses location/equipment has been left in a safe condition YES . ready to resume normal operations. YES operations. YES
If not completed give reason why:-
Wan Mohamad Ridhuan
Name: ____________________ Name: ____________________ Name: ____________________
Signature: ____________________ Signature: ____________________ Signature: ____________________
22032024
Date: ____________ 1300HRS
Time: ____________ Date: ____________ Time: ____________ Date: ____________ Time: ____________

Permit Distribution:- Top Copy – Displayed At Worksite 2nd Copy – Control Room 3rd Copy – Applicant

STOP WORK AND EVACUATE AREA ON HEARING ANY EMERGENCY ALARM

 GAS TEST FORM
Pre-Printed No:
0000185 (INVALID WITHOUT AN ACCOMPANYING WORK PERMIT)
Daily Suspended
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
SECTION 1 GENERAL INFORMATION (AGT)
PTW NO.: 0000185 SITE EQUIPMENT TAG DATE
Bayan .................... 19 Mar 2024
CSEC NO.: 951118-03-6521 AREA/UNIT EQUIPMENT SERVICE
BYDP-D ....................

SECTION 2 AUTHORISED GAS TESTER DETAILS (AGT)

NAME: .................... PERSONAL ID NO: .................... COMPANY: ....................
CERTIFICATION NO.: .................... ISSUE DATE: .................... EXPIRY DATE: ....................

SECTION 3 GAS TEST RECORD (AGT)

No DATE TIME %O2 % LEL H2S (ppm) Mercury (mg/m3) Benzene (ppm) SIGNATURE

GAS TEST ACCEPTABLE PARAMETERS

Working in a Confined Space Work other than Confined Space
O2: 20% to 20.9% without Breathing Apparatus O2: 20% to 20.9%
LEL: < 1% of LEL LEL: < 10% of LEL
H2S: ≤ 5 ppm H2S: ≤ 5 ppm
Mercury: ≤ 0.0125 mg/m3 Mercury: ≤ 0.0125 mg/m3
Benzene: ≤ 0.25 ppm Benzene: ≤ 0.25 ppm

Certificate :- Top Copy – Displayed at Work Site, 2nd Copy – Control Room
STOP WORK AND EVACUATE AREA ON HEARING ANY EMERGENCY ALARM