CYBER PARK-3

ARANETA CENTER, CUBAO, QUEZON CITY

WORK PERMIT
COMPANY: JP MARSEAN PAINTMASTERS INC. CONTROL NO:
DATE OF WORK: WORK LOCATION :
TIME OF WORK: 7AM – 6PM
NAME OF SUPERVISOR: MR. FREDDIE CASTILLO
NUMBER OF WORKERS:
Description of works: (List all task involved in this work)

*PAINTING & RUBCON WORKS

Safety Requirements: (List all safety requirements to be able to perform the task safely;
1.HARD HAT 4. SAFETY SHOES
2.FULL BODDY HARNESS 5. GOGGLES
3.HAND GLOVES 6. RESPIRATORY MASK
Other Permits Required: (Check all that applies; approved copies should be attached to this form;
( ) HOT WORK ( ) CONFINED SPACE PERMIT ( ) SCAFFOLDING
( ) LOCK-OUT/TAG-OUT ( ) EXCAVATION/TRENCHING ( ) HEAVY LIFTING
( ) GOV. REGULATIONS ( ) OTHERS(specify)
Major Equipments to be used: (The facility owner should be informed of the major equipment that will
be used while work is on-going in his area of responsibility. This will enable
him to assess whether such will affect his operating plan. Check all that applies)
( )CRANE ( )PAYLOADER ( )WELDING EQUIPMENT ( )CUTTING TORCH
( )BOOM TRUCK ( )MAN LIFT ( )FORKLIFT ( )TRUCKS
( )GRADER ( )BULLDOZER ( )JACKHAMMER ( )DRILL
( )COMPRESSOR ( )GENERATOR ( )OTHERS (specify)
Other Requirements (check all that applies and answer yes if complied or completed already)
( )Drawings, Completed?
( )Necessary supporting attachments and permits. Completed?
( )Work Area Safety Plan. Completed?
( )Others, please specify.
SITE ORGANIZATION : (List all personnel working on-site)
Supervisor / Foreman / Leadman:
Workers :
See attached
STAFF: WORKERS:
Project in Charge
KEVIN PAGUNSAN
JORNARD SAÑOL
QAQC Officer
RODERICK ESPINOSA
Safety Officer / Admin
1. ABAGENCIA, EMMANUEL 10. MACASE, ROQUEL
LUISITO DELIMA 19. VIDALLON, ERNESTO
2. ANDRADE, BERNARD 11. MAGLASANG, NELSON
MARJORIE TAIPAN 3. BERDIN JR. ROGER 12. MIRANDA, SHELA
20. YBAÑEZ JR., VERGILIO
Warehouseman / First Aider 21.
4. BUJAWE JR, DOMINADOR 13. MENDENILLA, RENANTE
BENTLEY BILLON 22.
5. CAGUINGIN, LEO SANTOS 14. MENDENILLA, RODINO
23.
6. CAMAR JR, ROSALINO 15. REAL, MARVIN
24.
7. DANIEL, MARCELINO 16. SABDULLAH, SIONG
25.
8. GANI, KAMARUDIN 17. SAWALAL, AJID
26.
9. GARCIA, RAYNALDO 18. VELOS, JOHN POUL
 WORK AREA SAFETY PLAN

Emergency Response: (list the emergency contact persons and contact numbers)
NAMES CONTACT NO.
Project in charge: Arch. Rene A. Olap 09173219496
Site Manager: Engr. Alejandro I. Prado 09454169416
Safety Officer: Richard R. Ontangco 09319034188
Project Nurse: Gerry L. Iggo 09356214496
EVACUATION AREA: (Identify a safe area for evacuation during site emergency)

JOB HAZARD ANALYSIS

ITEM ACTIVITY
1 MASONRY NEUTRALIZER
APPLICATION
2 SKIMCOAT APPLICATION
3 PRIMER APPLICATION
4
SPOT-PUTTY APPLICATION
5 SANDING APPLICATION
6 SPOT-PRIMER APPLICATION
7 TOPCOAT APPLICATION
8 GRINDING WORKS
HAZARD
*Inhalation of dust &
chemicals
*Eye & skin irritation
*Trip, slip, fall from heights.
*Puncture and Electrocution
*Abdominal pain, head ache,
laceration, abrasion
ingestion, vomiting, injury
from flying debris
ACTION TAKEN
*Wear googles, full body harness, longsleeve
uniform and hard hat.
*Wear respiratory mask & hand gloves.
*Wear safety shoes & maong pants.
*Competent Person.
*Always conduct toolbox.
*Meeting for Safety Concern & reminders
Used PPE and check the area if safe. Remove all
obstruction before start the work.
ALWAYS WEAR COMPLETE PPE.

Prepared by: Noted by :

MARJORIE TAIPAN / LUISITO DELIMA KEVIN PAGUNSAN / JORNALD SAÑOL_

Signature Over Printed Name PM / PIC – Contractor

Approved by :

ARCH. R.OLAP / ENGR. A.PRADO A.CORVERA / R.ONTANGCO / R.DELA CRUZ/ R. SILVOSA

PM / SM – DATEM Inc. SO – DATEM Inc.

Closed-Out Remarks by the assigned Safety Officer (indicate signature, date and time ):

Copy furnished: Operation/Safety