PERMIT TO WORK



COMPANY DETAILS:

Activity:
Hot Work
Confined Space
Working At Height
Radiation/Radiasi
Heavy Equipment
Electrical Work
Civil Work
Others

ISOLATION:

No Check & isolate below items for safety Remark
1 Barricade/Warning Sign/Traffic Control
2 Hazardous Material/Waste
3 Log Out Tag Out (LOTO) procedure for Electrical Power Source
4 Pipeline (Water Source/Vapour/Gases/Others)

EQUIPMENT:

Please list the equipment used

PERSONAL PROTECTIVE EQUIPMENT (PPE):

No Personal Protective Equipment (PPE)
1 Body Harness (with Lanyard and Life line)
2 Ear Plugs
3 Gloves
4 Respirator (APR/SCBA/ASR)
5 Safety Boots
6 Safety Goggles
7 Safety Helmet

AUTHORIZED WORKER:

Name MyKad / Passport No N-CSPS N.

NOTE:

  • The regulation & precaution must be taken as refer form, any of the unsafe conditions such as hazardous atmospheres & lack of safety measure the permit will be suspended/cancelled immediately by Authorized Work Approver.
  • If doing hot work, precaution of possibility hazard from fire/ explosion must been taking care of & for some cases such as the existing of the flammable gases area, Fire Watcher are needed to monitor safe work conditions.
  • If doing hot work, precaution of possibility hazard from fire/ explosion must been taking care of & for some cases such as the existing of the flammable gases area, Fire Watcher are needed to monitor safe work conditions.
  • Area must be clean & free from all readily combustible materials within 15 meters.
  • All electrical equipment must be earthing properly.
  • Permit must be display at work location together with Job Safety Analysis (JSA)

  I have read and understood notes above