AH SOON CONSTRUCTION SDN BHD

45, Jalan PS 8
Prima Selayang,
68100 Batu Caves
Selangor
PERMIT TO WORK
Location Re. No.: ASCSB/PTW/_____________
Company / Department: Request by:
Work Schedule Start Date: Time: Finish Date: Time:
Number of employees working on job: HSE Personel In Charge:
Contact No:

SPECIFIED TYPE OF WORK *(Attach additional specified checklist)

Valid for 7 days 3 Days 1 day
Excavation Working Near / Above Water Confined Space
Working At Height Night Work Hot Work (Welding, cutting, grinding)
Piling Electrical Works (exceed 600V)
Demolition Works Lifting (Mobile/Crawler/Tower Crane)
Blasting

AREA / EQUIPMENT / WORK PREPARATION ** (Additional Justification to ASC SB when the answer is 'NO) Remarks

1 Has the JSA / HIRARC been approve and issued? YES NO

2 Does the work area has been isolated / barricade /tagged? YES NO
3 Are the equipments / power tools correct for the job, in good order and inspected? YES NO
4 Is there any modification done to the Power Tools? YES NO
5 Has the PTT Briefing conducted by respective supervisor on specific task? YES NO
6 Does appropriate signages displayed accordingly? YES NO
7 Does Traffic Management Plan (TMP) be implemented accordingly? YES NO
8 Has the Emergency & Evacuation Procedure brief to the workers? YES NO

PERSONAL PROTECTIVE EQUIPMENT (PPE) & OTHER REQUIREMENTS

Safety Helmet, Safety Shoes and High Vis. Vest Radio communication
Chemical Goggles Exhaust Ventilation (Type:…...........
Safety Glasses Suficient Lighting
Face Shield / Welding Shield Fire Extinguisher
Hand Gloves (Type: Cotton / Rubber / Latex / Welding Glove / …................. First Aid Box
Full Body Safety Harness Barricades (Type: Tape / Rope / Wooden / Steel GI Pipe / ….........
Ear plugs / Ear Muffs Waste Disposal Facilities
Respirators (Type:…...................... Chemical Spill Kit Equipment
Chemical Protective Clothing Fire Alarm System / ERT Equipment
Life Jacket Others:…............
Life buoys

PERMIT TO WORK ISSUANCE

I hereby certify that I have read and examined the Permit To Works Checklist attached and acknowledge it.
All provisions of applicable legal requirement shall be complied with whether specific herein or not.
The granting of this permit does not presume me and the workers under my control to violate or cancel the provisions.

Applied by Contractor Representative / Signature: Time:

Engineer / Supervisor
Name Date:

Designation

PERMIT TO WORK REVIEWED PERMIT TO WORK APPROVAL

I hereby acknowledge all the items mention in this PTW and I hereby approve and give permission for the operation to be carried
the Specific Works Checklist attached are certified true. Should out / accomplished / execute base on the requirements stated in this PTW.
there be any inconsistencies or variation in any of the stated item,
this PTW shall automatically be withdrawn.

Reviewed by ASC SB Signature: Approved by ASC SB Signature:

HSE Personnel Project Manager
Name Name

Designation: Designation:

Date: Date:

1 Permit To Work (PTW) shall be apply 24 hours before start works.

2 Original PTW shall be kept and recorded by Site Personnel
3 Sign and approve copy of PTW shall be displayed at work area all the time.
4 Addional Checklist for Specific Works / Task shall be attached accordingly.
5 Keep all areas clean. Remove all trash / unnecessary tools / equipment at end of shift or after completion of the task.