L4 02.02 GTR PTW-JHA Training Material

•
•
•

•
•

Internal

•

•
•
•

•
•

Internal

•
•

•
•
•

•
•
•
•

Internal

Internal

Internal

Internal

1. PROCESS AREA

Operational areas as defined by parameter fencing such as gas
processing facilities, installations, manufacturing plants,
terminal, jetty and storage, metering station, compressor
station, valve station and cathodic protection station.
 Process Area is an area within the OPU site where hydrocarbon gas
and other hazardous products are present.

2. NON PROCESS AREA

All areas outside the Process Area such as administration
building, right-of-way, canteen, workshop, warehouse, fire
station, clinic, sports complex and guard stations.
 The Non-process Area is area outside the Process Area
generally considered free from hydrocarbon gas

Internal

1. ROUTINE JOBS / ACTIVITIES

Activities which are perform regularly by technician /
operators such as topping up lube oil, visual inspection,
ground and air surveillance, line tracing and observation.

2. NON ROUTINE JOBS / ACTIVITIES

Activities which are outside the regular operation of an
operating facility. In this respect maintenance and
construction activities are considered as non-routine.

3. WORK AREA – Site Access Non Process

Process Non-Process Area

Pipeline – Facilities – Compressor

Internal

PERMIT/CERTS Validity

PTW Cold 7 consecutive days with revalidation at each shift
PTW Hot Daily request & closed- 8 Hrs. + 4 Hrs. revalidate
Confined Space Entry
Radiation Maximum validity/life period is seven (7) days
Excavation
Road Obstruction The certificate will be valid until a maximum period
Vehicle Entry of three (3) month, when the specified work permit
Limit Of Electrical Access expires, after seven (7) days the certificate must
Lifting be re-validated every seven (7) days.
Fire Water Usage
Portable Equipment Temporary Installation
Electrical Isolation
Safety Sys Bypass/override
Physical Isolation

Internal

CHANGE OF WORK PERSONNEL
• If any change to Work Leader, new

permit shall be issued
• Any change to AA/RA within the same

shift, revalidation is required

Internal

Any change of work plan or suspension of work

• Work being carried out under a PTW system
may have to be stopped before the work is
completed.

• After 48 hours of incomplete or suspended
work without any activity at work site, PTW
will be automatically invalid and shall be
closed by handing back to RA and AA.

Internal

The PTW system – Action in an emergency.

 RA & WL shall deliver the emergency procedure during
TBT (tool-box-talk).

 A formal suspension of permits by way of their return to
a central control (Area Owner/AA).

 Whenever there is an emergency alarm or the evacuation
alarm is sounded, the PTW shall be automatically
suspended and the work must cease immediately. A new
permit must be issued for the affected area only.

 Work permit in areas which are not affected by the
emergency will only be allowed to continue the work after
getting endorsement from AA

Internal

JOB COMPLETION
When the job is complete, the Receiving Authority
(RA) signs off the Work Permit and returns it to the
Approving Authority (AA) who inspects the job site,
and if satisfied that work, including cleanup is
completed, he/she signs off on the original and both
copies to show that the permit is now terminated.

Internal

•

•
•

Internal

•
•

•

Internal

Internal

• PTW Cold (Green Colour) - Cold Work Permit is a green colour.
• Size A4 and is used for controlling hazards and hazardous work

activities that does not involve any hot surfaces, sources of
ignition or naked flames, e.g. pressure testing, spading, calibration,
erect and dismantle scaffolding, manual painting, insulation work etc.
• Cold Work Permit used for the execution or other work than Hot
Work.

Internal

PTW – COLD WORK PERMIT (GREEN – A4 size)

A Serial No. C 0000000 PERMIT TO WORK - COLD

PERMITS POD NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY

Apart from the minimum information OPERATING
required about the job to be described by REGIONS/DEPTS
the Permit Applicant and space for
authorization by the Approving and B SECTION 1 - REQUISITION
Receiving Authorities, it shall contain as a
minimum the following sections:- APPLICANT'S NAME : ..................................................................................................... DEPT. /CO.: ................................................................... Required On Expected Completion
Date : Date :
Section 1 : Requisition STAFF NO. / IC NO. : ...................................................................................................... TEL NO. : ...................................................................... Time : Time:
Section 2 : Hazards/Hazardous Activities LOCATION/FACILITY : .................................................................................................... AREA / UNIT....................................................................
Section 3 : Personal Protective Equipment EQUIPMENT NO. : ........................................................................................................... SAP/ W. ORDER NO. : ....................................................
Section 4 : Supporting Certificates
WORK DESCRIPTION :
/Documents
Section 5 : Worksite Preparation C SECTION 2 - HAZARDS / HAZARDOUS ACTIVITIES ( To be filled by WL / RA )

/Precautions Moving Eqpt. Parts Biological Hydrocarbon TENORM Pressure Test Loading / Unloading Manual Excavation Working at Height
Section 6 : Approval Flammable Materials High Pressure Chemical Noise Lifting Calibration Manual Drilling Chemical Handling
Section 7 : Revalidation Ergonomic................... Electricity Hot / Cold Media Falling Painting Others
Section 8 : Hand back Others ........................ H2S Cold Cutting

D SECTION 3 - PERSONAL PROTECTIVE EQUIPMENT ( To be filled by WL / RA )

Head / Eye & Face Protection Respiratory Protection Hearing Protection Hand Protection Foot Protection Body Protection Fall Protection
Helmet Half Mask Respirator Ear Plug Cotton Glove Safety Shoes/Boot Coverall Full Body Harness
Safety Glass Full Face Respirator Ear Muff Leather Glove Safety Rain Boot Chemical Suit Fall Arrest Equipment
Dust Mask Electrical Shoes/Boot
Goggle Rubber Glove Apron Others
Face Shield Chemical Glove Life Vest ............................................

E SECTION 4 - SUPPORTING CERTIFICATE / DOCUMENT ( To be filled by WL / RA )

Electrical Isolation - Cert. No............................................................ Excavation - Cert. No........................................... Authority Clearance { DOSH (PTI), JKR, TNB, JPS, STM }
Safety System Bypass/ Override - Cert. No..................................... Physical Isolation Cert No: .................................. Drawing No : ..........................................................
Limit of Electrical Access - Cert.No. ................................................. Method Statement / JSA Previous PTW Nos.: ...............................................
Road Obstruction - Cert. No. ........................................................... Pre-Job Minutes of Meeting Others......................................................................

F Endorsed By RA : Name :.................................................................. Signature :................................................ Time :................................. Date :...................................

SECTION 5 - WORKSITE PREPARATION / PRECAUTIONS (To be filled by AA )

G PRECAUTIONS TAKEN BY AA H CONDITIONS TO BE IMPLEMENTED BY RA / WL

Valve Isolation Line Disconnected Drained Notify surrounding parties Barricade & Warning Sign Contact Area / Panel Operator before work start
Valve Chainlock Blinded / Spaded Tagging N2 Purged / Steam Out Housekeeping Contact Area / Panel Operator on completion
Double Block & Bleed Depressurised Venting To be Counter Signed by :................................ Scaffolding Inspection Others ..........................................................
Flush with Water Others Secure Tools/Materials against Falling
Special Precautions :- .............................................................

I JOINT SITE VISIT BEFORE WORK START YES NO (To be filled by AA )

I / We have personally checked the area and equipment to be worked on and satisfy the work requested can be carried out safely.

RA/ RA REPRESENTATIVE AA/ AA REPRESENTATIVE
Name / Designation :.................................................................................................. Name / Designation
Signature : ..............................................................Date :.......................................... :.............................................................................................................

SECTION 6 - APPROVAL Signature : .........................................................................Date
:..........................................

J RECEIVING AUTHORITY (RA) / RA REPRESENTATIVE K APPROVING AUTHORITY ( AA ) L AGREEMENT BY WORK LEADER ( WL )

Name : Date : Name : Date : Name : Date :

Signature : Time : Signature : Time : Signature : Time :

M SECTION 7 - REVALIDATION

DATE TIME RA / WL AA TIME RA / WL AA
Start Stop Name Name Start Stop Name
Initial Initial Initial Name Initial

N SECTION 8 - HAND BACK ( To be filled by RA / WL ) ( PTW to be closed within 24 hours upon work completion or permit expiry )

Incomplete hand-back. ( equipment status, reason for hand-back, etc.) Work completed Housekeeping completed
Remarks :

O ENDORSED BY RA P ACCEPTED BY AA
Name : Name :
Signature : Date : Date :

Time : Signature : Time :

Permit Distribution - Original (White) : Displayed at Work Site Copy No. 1 (Yellow) : Contol Room / AA Office Copy No. 2 (Pink) : Receiving Authority August 2003 Rev :
1

STOP ALL WORK AND EVACUATE THE AREA ON HEARING EMERGENCY ALARM / SIREN

Internal

PTW – Section 1

A Serial No. C 0000000 PERMIT TO WORK - COLD

PGB NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY

OPERATING
REGIONS/DEPTS

REQUISITION.

The Permit Applicant fills in Section 1 of the Work Permit form (in triplicate) with the specific
details of the job to be done, specifying the equipment tag numbers with its exact location.
He/she must indicate the required date for work to commence and expected completion.

B SECTION 1 - REQUISITION Required On Expected Completion
Date : Date :
APPLICANT'S NAME : ..................................................................................................... DEPT. /CO.: ................................................................... Time : Time:
STAFF NO. / IC NO. : ...................................................................................................... TEL NO. : ......................................................................
LOCATION/FACILITY : .................................................................................................... AREA / UNIT....................................................................
EQUIPMENT NO. : ........................................................................................................... SAP/ W. ORDER NO.: ....................................................
WORK DESCRIPTION :

.Provide detail information i.e. Work Descriptions, equipment, area and specific location

Internal

PTW – Section 2

HAZARDS/HAZARDOUS ACTIVITIES.

This section provided list of hazards and hazardous activities.
WL/RA and AA shall evaluate and identify the hazards and hazardous activities to the work.
Additional info may be specified if required. RA shall endorse in this section indicating that
he has agreed to the requisition.

C SECTION 2 - HAZARDS / HAZARDOUS ACTIVITIES ( To be filled by WL / RA )

Moving Eqpt. Parts Biological Hydrocarbon TENORM Pressure Test Loading / Unloading Manual Excavation Working at Height
Flammable Materials High Pressure Chemical Noise Lifting Calibration Manual Drilling Chemical Handling
Ergonomic................... Electricity Hot / Cold Media Falling Cold Cutting Painting Others
Others ........................ H2S

What does TENORM stand for?
Technologically Enhanced Naturally Occurring Radioactive Materials (natural materials in which the concentration of radioactive
material is enhanced)

Internal

PTW – Section 3

PERSONAL PROTECTIVE EQUIPMENT.
WL/RA and AA shall assess the work and identify the relevant PPE required.

D SECTION 3 - PERSONAL PROTECTIVE EQUIPMENT ( To be filled by WL /RA )

Head / Eye & Face Protection Respiratory Protection Hearing Protection Hand Protection Foot Protection Body Protection Fall Protection
Ear Plug Cotton Glove Full Body Harness
Helmet Half Mask Ear Muff Leather Glove Safety Shoes/Boot Coverall Fall Arrest
Rubber Glove Equipment
Safety Glass Respirator Chemical Glove Safety Rain Boot Chemical Suit
Others......................................
Goggle Full Face Electrical Apron
Face Shield Respirator
Shoes/Boot Life Vest
Dust Mask

Internal

PTW – Section 4

SUPPORTING CERTIFICATE/DOCUMENT.

WL/RA and AA shall indicate the supporting certificate / document required for the
work permit.
RA to endorse the permit requisition by signing upon satisfactorily completion of
Section 1,2,3,& 4.

E SECTION 4 - SUPPORTING CERTIFICATE / DOCUMENT ( To be filled by WL / RA )

Electrical Isolation - Cert. No............................................................ Excavation - Cert. No........................................... Authority Clearance { DOSH (PTI), JKR, TNB, JPS, STM}
Safety System Bypass/ Override - Cert. No..................................... Physical Isolation Cert No: .................................. Drawing No : ..........................................................
Limit of Electrical Access - Cert.No. ................................................. Method Statement / JSA Previous PTW Nos.: ...............................................
Road Obstruction - Cert. No. ........................................................... Pre-Job Minutes of Meeting Others......................................................................

F Signature :................................................ Time :................................. Date :...................................

Endorsed By RA : Name :..................................................................

Internal

PTW – Section 5

WORKSITE PREPARATION/PRECAUTIONS.

AA shall evaluate and identify precautions to be taken by Operation and also specify the
precautions and conditions to be taken by RA/WL of the worksite and review the contents of
section 1 to 4. AA will decide the requirement on joint site inspection for the work. RA/WL shall
implement the specified precautions and ensure the worksite preparation is completed prior to
inspection. AAR and RAR shall jointly inspect the worksite when indicated by the AA. RAR and
AAR to sign (STEP I) when all working conditions specified are complied with and the
worksite is safe to commence work.

SECTION 5 - WORKSITE PREPARATION / PRECAUTIONS (To be filled by AA )

G PRECAUTIONS TAKEN BY AA H CONDITIONS TO BE IMPLEMENTED BY RA / WL

Valve Isolation Line Disconnected Drained Notify surrounding parties Barricade & Warning Sign Contact Area / Panel Operator before work start
Valve Chainlock Blinded / Spaded Tagging Housekeeping Contact Area / Panel Operator on completion
Double Block & Bleed Depressurised Venting N2 Purged / Steam Out Scaffolding Inspection Others ..........................................................
Flush with Water To be Counter Signed by :................................ Secure Tools/Materials against Falling
Special Precautions :- Others .............................................................

I JOINT SITE VISIT BEFORE WORK START YES NO (To be filled by AA )

I / We have personally checked the area and equipment to be worked on and satisfy the work requested can be carried out safely.

RA/ RA REPRESENTATIVE AA/ AA REPRESENTATIVE

Name / Designation :.................................................................................................. Name / Designation :.............................................................................................................
Signature : ..............................................................Date :.......................................... Signature : .........................................................................Date :..........................................

Internal

PTW – Section 6

APPROVAL.

 RA/RAR shall endorse if he agreed with work site preparation/precautions specified by AA.
 AA shall approve the permit if all requirements are met. RA/RAR shall brief WL on the PTW

requirements.
 WL shall sign upon understanding and agreeing with the requirement specified in the Work

Permit.
 The original of the approved work permit to be displayed at worksite at all time, copy no.1

(yellow copy) to be kept in control room/permit office and copy no. 2 (pink copy) to be kept
by RA.

SECTION 6 - APPROVAL K APPROVING AUTHORITY ( AA ) L AGREEMENT BY WORK LEADER ( WL )

J RECEIVING AUTHORITY (RA) / RA REPRESENTATIVE

Name : Date : Name : Date : Name : Date :
Signature : Time : Signature : Time : Signature : Time :

Internal

PTW – Section 7

REVALIDATION.

 Whenever the Work Permit required to be extended, RA/RAR shall collect all copies of the

permit and bring back to AA Office/control room/regional office .

 RA and AA shall sign for revalidation at every shift cycle or 12 hours duration.

 When the time specified on the permit expires, work must stop unless the time is

extended by the approving authority.
 RA/RAR is responsible for checking with the AA for permit extension
 Only RA/WL can request for permit revalidation from AA.

M SECTION 7 - REVALIDATION

DATE TIME RA / WL AA TIME RA / WL AA
Start Stop Name Start Stop Name Name
Name Initial Initial Initial Initial

Internal

PTW – Section 8

HAND BACK.

 For suspension of work, the Work Permit will be withdrawn immediately and brought to AA Office. AA

must be notified on work stoppage / suspended.
 Once the work completed WL shall complete Section 8 to describe the condition of worksite. RA will

endorse the closure of Work Permit.
 The Work Permit shall be taken to AA Office for accepted of closure by AA.
 If the work is not completed RA/RAR/WL shall notify AA on the status of the work and collect all

copies for revalidation or closing.
 All Work Permit shall be closed within 24 hours of work completion.
 After 48 hours of incomplete/suspended work without any activity at work site, PTW will be

automatically invalid and shall be closed by handing back to RA and AA.
 Weekend/Public Holliday: PTW must be closed on the first day of the following week if the job

completed on last day of week (e.g. Thursday or Friday or the next working day). However, the

WL/RA/AAR shall inform and get agreement from AA through SMS/e-mail on the hand back/closure of

the PTW.
N SECTION 8 - HAND BACK ( To be filled by RA / WL ) ( PTW to be closed within 24 hours upon work completion or permit expiry )

Incomplete hand-back. ( equipment status, reason for hand-back, etc.) Work completed Housekeeping completed
Remarks :

O ENDORSED BY RA P ACCEPTED BY AA
Date : Date :
Name : Time : Name : Time :
Signature : Signature :

Internal

Internal

• PTW - Hot (Red Colour) - Hot Work Permit is a red colour.
• A3 size and is used for controlling work activities with increased risks and hazards such as dealing

with source of ignition, open flame, spark producing, flammable release, e.g. welding, grinding,
cutting, hot tapping, power brushing, handling pyrophoric materials, photo taking activity at process
area, non-intrinsically safe (IS) battery operated equipment.
• Hot Work Permit also used for entry into confined space and for vehicle entry into process area.
• In addition to the standards sections, PTW - Hot Form also includes additional requirements for hot
work activities and confined space entry sections. This cover process and non-process area.

Internal

PTW – HOT WORK PERMIT (RED – A3 size)

A PGB Serial No. H 0000000 PERMIT TO WORK - HOT

OPERATING NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
REGIONS/DEPTS

B SECTION 1 - REQUISITION ( To be filled by WL ) I CONDITIONS TO BE IMPLEMENTED BY RA / WL

APPLICANT'S NAME : ....................................................................... DEPT. / CO. :........................................................................ Required On Expected Completion Remove Flammable Material Fire Hose Spark Arrestor Cover sewer / drain / sump
Date : Remove Combustible Material Fire Blanket N2 or Steam Purge Locate spark producing eqpmt. away from sewer / trench / pipe rack
STAFF NO. / IC NO. : ......................................................................................TEL. NO................................................................................ Date : Fire Extinguisher Fire Retardent Screen Hot Tapping Procedure Attached Others : Specify............................................

LOCATION/FACILITY : ................................................................................... AREA / UNIT....................................................................... Time : Time:

EQUIPMENT NO. : .......................................................................................... SAP / W. ORDER NO : ....................................................... TYPE OF HOT WORK Fire Watch Name 1)..........................................................................................2)........................................................................................................

WORK DESCRIPTION : HOT TAPPING FLAMMABLE RELEASE J GAS TEST REQUIREMENT (To be filled by HWAA)
OPEN FLAME SPARK PRODUCING
PHYROPORIC VEHICLE ENTRY LEL Check Before Work Starts / After Break Every .......................... Hours Interval Continuous Gas Monitoring
Every .......................... Hours Interval Operator On Standby
OTHERS ................................................................. H2S Test Before Work Starts / After Break Every .......................... Hours Interval No Venting or Draining of Hydrocarbon
within 10 metres Radius.
C SECTION 2 - HAZARDS / HAZARDOUS ACTIVITIES ( To be filled by WL /RA) Oxygen Test Before Work Starts / After Break

Power Tools Hydrocarbon Flammable Materials Blasting Welding Loading / Unloading Pressure Test Special Precautions...........................................................................................................................................................................................................................................................
Non Intrinsic Eqmt. Chemical Biological ...........................................................................................................................................................................................................................................................................................
Electricity Falling High Pressure Excavation Grinding Radiography Lifting
Generator / Compressor Hot / Cold Media Crane
Moving Eqpt. Parts Noise Ergonomic .................... Interlock Bypass Blowdown Working at Height Hot Cutting
TENORM Others ...........................
H2S Piling Power Brushing Confined Space Entry Hydrojetting ...........................................................................................................................................................................................................................................................................................

Hot Tapping Junction Box Opening Pigging Drilling This permit is approved provided the above conditions and precautions are implemented.

Work on O2 Handling Eqmt. Others...............................................

( To be filled by WL /RA) K Hot Work Approving Authority Signature Department Designation Date

D SECTION 3 - PERSONAL PROTECTIVE EQUIPMENT

Head / Eye & Face Respiratory Hearing Hand Foot Body Fall Protection CONFINED SPACE ENTRY CERTIFICATE ( To be filled by CAA )
Helmet Half Mask Respirator Ear Plug Cotton Glove Safety Shoes/Boot Coverall Full Body Harness
Safety Glass Full Face Respirator Ear Muff Leather Glove Safety Rain Boot Chemical Suit Fall Arrest Eqpt. A TYPE OF ENTRY ALLOWED B CONDITIONS TO BE IMPLEMENTED BY RA / WL
Goggle Dust Mask Rubber Glove Electrical Shoes/Boot Apron Safety Line
Face Shield SCBA / Airline Set Chemical Glove Life Vest Others......................
Respirable Atmosphere Life Line Personal Oxygen Monitoring Meter Locate Mobile Equipment Away From Manhole
[ O2 19.5 - 22% & LEL < 10% & Toxic < PEL ] Personal H2S Meter Rescue & Evacuation Plan Attached
E SECTION 4 - SUPPORTING CERTIFICATES / DOCUMENT ( To be filled by WL /RA ) Continuous Ventilation Barricade and Warning Signs Confined Space Entry Checklist Attached
Harmful Atmosphere Continuous Gas Monitoring Extra Low Voltage Lighting (max 50V)
Pre-Job Minutes of Meeting [ O2 > 22% or LEL 10% or Toxic PEL ] Personal Distress Unit BA Escape Set First Entry Using SCBA or Airline set
Authority Clearance {DOSH (PTI), JKR, TNB, JPS, STM} N2 Hose Disconnected
Confined Space Entry - Cert. Lifting - Cert. No..................................................... JSA Irrespirable Atmosphere Tripod Breathing Apparatus to be Used :
Excavation - Cert. No ........................................... Road Obstruction - Cert. No.................................. Previous PTW Nos. :............................................ [ O2 < 19.5% ]
Radiation - Cert. No.............................................. Limit Of Electrical Access - Cert.No..................... Drawing No.: ....................................................... SCBA Half mask
Electrical Isolation - Cert. No................................. Physical Isolation - Cert. No.................................... Others.................................................................... Airline Full face mask
Vehicle Entry - Cert. No........................................ Box-up Certificate/Document
Safety Sys. Bypass/Override - Cert. No................ Method Statement Safety Watch Name 1)........................................................................2)..........................................................................

C GAS TEST REQUIREMENT

F Date :................................... LEL Check Before Work Starts / After Break Every .......................... Hours Interval Continuous Gas Monitoring
Endorsed By RA : Name :....................................................... Signature :................................................ Time :................................. H2S Test Before Work Starts / After Break Every .......................... Hours Interval Operator On Standby
Oxygen Test Before Work Starts / After Break Every .......................... Hours Interval No Venting or Draining of Hydrocarbon
SECTION 5 - WORKSITE PREPARATION / PRECAUTIONS (To be filled by AA) within 10 metres Radius.

G PRECAUTION TAKEN BY AA H CONDITION TO BE IMPLEMENTED BY RA / WL

Tagging N2 Purged/Steam Out Running Water On Secure Tools/Materials against Falling Special Precautions...........................................................................................................................................................................................................................................................
Eqmt/Line Drain/Depressurise/Purge Notify Surrounding Parties Lock Out and Tag Out Contact Area/Panel Operator/GCC before work start ...........................................................................................................................................................................................................................................................................................
Valves Isolation Electrical Isolation Barricade and WarningSign Contact Area/Panel Operator/GCC on completion ............................................................................................................................................................................................................................................................................................
Flush with Water To be CountersignedBy ............................ Scaffold Erected and Safe to be Used To be Accompanied by Area Operator / AGT
Valve Chain Locked Open/Close Others ...................................................... Equipment/Line Spaded as per List Others........................................................ I have personnally checked that all control measures to prevent release of hazard have put in place and complied with those conditions under this certificates

L JOINT SITE VISIT BEFORE WORK START YES NO ( To be filled by AA ) D Certificate Approving Authority Signature Department Designation Date

I/ We have personally checked the area and equipment to be worked on and satisfy the work requested can be carried out
safely
AA / AA REPRESENTATIVE
RA / RA REPRESENTATIVE M INITIAL GAS TEST RESULT ( To be filled by AGT )
Test Standard Initial Result Request for initial gas test for confined space entry
Name : ................................................................. Designation............................................. Name : ................................................................. Designation....................................

Signature : ........................................................... Date......................................................... Signature : ............................................................ Date.................................................. Oxygen 19.5 % to 22 % Name : ................................................................................. Signature : ................................................

SECTION 6 - APPROVAL APPROVING AUTHORITY (AA) P AGREEMENT BY WORK LEADER (WL) Combustible < 10 % LEL I have conducted the initial gas test and satisfy that the work requested can be carried out as approved.
N RECEIVING AUTHORITY (RA) / RA REPRESENTATIVE O
Toxic Not more than PEL AGT Name : ............................................................................................. Staff No : ............................
T1
Name : Date : Name : Date : Name : Date : T2 Signature :........................................................ Date :.................................. Time : .......................
Signature : Time : Signature : Time : Signature : Time :

R SECTION 8 - HAND BACK ( To be filled by RA / WL ) ( PTW to be closed within 24 hours upon work completion or permit expiry )

Q SECTION 7 - REVALIDATION Incomplete hand-back. ( equipment status, reason for hand-back, etc.) Work completed Housekeeping completed
Remarks :
DATE TIME RA / WL Initial AA Initial TIME Stop RA / WL Initial AA Initial
Start Stop Name Name Start Name Name

S ENDORSED BY RA T ACCEPTED BY AA
Name : Date : Name :
Signature : Time : Signature : Date :
Time :

Permit Distribution- Original ( White ) : Displayed at Work Site Copy No. 1 ( Yellow ) : Contol Room / AA Office Copy No. 2 ( Pink ) : Receiving Authority August 2003 Rev : 1

STOP ALL WORK AND EVACUATE THE AREA ON HEARING EMERGENCY ALARM / SIREN.

Internal

PTW – Section 1

PGBA PERMIT TO WORK - HOT
Serial No. H 0000000
OPERATING NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
REGIONS/DEPTS

REQUISITION.

The Permit Applicant fills in Section 1 of the Hot Work Permit form (in triplicate) specifying
details of the job to be done, the equipment numbers and location of the wok.

He/she must indicate the type of hot work or confined space entry to be carried out and
required date for work to commence and its expected completion.

2 SECTION 1 - REQUISITION ( To be filled by WL ) Required On Expected Completion

APPLICANT'S NAME : ......................................................................... DEPT. / CO. :........................................................ Date : Date :
STAFF NO. / IC NO. : ............................................................................... CONTACT NO....................................................... Time : Time:
LOCATION/FACILITY : ............................................................................... AREA / UNIT....................................................... ..
EQUIPMENT NO. : ................................................................................... SAP NO................................................................. TYPE OF HOT WORK

WORK DESCRIPTION : HOT TAPPING FLAMMABLE RELEASE
OPEN FLAME VEHICLE ENTRY
PHYROPORIC Others
SPARK PRODUCING

Internal

PTW – Section 2

.

This section provided list of hazards and hazardous activities.
WL/RA & RA shall evaluate and identify the hazards and hazardous activities to
the work. Additional info may be specified if required.

RA shall endorse in this section indicating that he has agreed to the requisition.

C SECTION 2 - HAZARDS / HAZARDOUS ACTIVITIES ( To be filled by WL / RA)

Power Tools Hydrocarbon Flammable Materials Blasting Welding Loading / Unloading Pressure Test
Non Intrinsic Eqmt. Chemical Biological Radiography Lifting
Electricity Falling High Pressure Excavation Grinding Working at Height Hot Cutting
Generator / Hot / Cold Crane Confined Space Entry Hydrojetting
Compressor Media Ergonomic................... Interlock Bypass Blowdown Pigging Drilling
Moving Eqpt. Parts Noise Others........................
TENORM H2S Piling Power Brushing

Hot Tapping Junction Box
Opening
Work on O2 Others...............................................
Handling Eqmt.

Internal

PTW – Section 3

PERSONAL PROTECTIVE EQUIPMENT.

WL/RA and AA shall assess the work and indicate the relevant PPE
required.

D SECTION 3 - PERSONAL PROTECTIVE EQUIPMENT ( To be filled by WL / RA)

Head / Eye & Face Respiratory Hearing Hand Foot Body Fall Protection
Full Body Harness
Helmet Half Mask Ear Plug Cotton Glove Safety Shoes/Boot Coverall Fall Arrest Eqpt.
Respirator Safety Line
Safety Glass Ear Muff Leather Glove Safety Rain Boot Chemical Suit
Full Face Respirator Others......................
Goggle Rubber Glove Electrical Shoes/Boot Apron
Dust Mask
Face Shield Chemical Glove Life Vest
SCBA / Airline Set

Internal

PTW – Section 4

SUPPORTING CERTIFICATE/DOCUMENT.

WL/RA and AA shall indicate relevant supporting certificate / document for
this work permit.

RA to endorse the permit requisition by signing upon satisfactorily
completion of Section 1,2,3,& 4.

E SECTION 4 - SUPPORTING CERTIFICATES / DOCUMENT ( To be filled by WL / RA )

Confined Space Entry - Cert. Lifting - Cert. No..................................................... Pre-Job Minutes of Meeting
Excavation - Cert. No ........................................... Road Obstruction - Cert. No.................................. Authority Clearance {DOSH (PTI), JKR, TNB, JPS, STM}
Radiation - Cert. No.............................................. Limit Of Electrical Access - Cert.No..................... JSA
Electrical Isolation - Cert. No................................. Physical Isolation - Cert. No.................................... Previous PTW Nos. :............................................
Vehicle Entry - Cert. No........................................ Box-up Certificate/Document Drawing No.: .......................................................
Safety Sys. Bypass/Override - Cert. No................ Method Statement Others....................................................................

F Date :...................................

Endorsed By RA : Name :....................................................... Signature :................................................ Time :.................................

Internal

PTW – Section 5

WORKSITE PREPARATION/PRECAUTIONS.

 AA shall identify and specify the conditions and precautions of the worksite and decide on

joint site inspection for the work.
 RA/WL shall implement the specified precautions and ensure the worksite preparation is

completed prior to inspection.
 AAR and RAR to jointly inspect the worksite if the AA requested the inspection.
 RAR and AAR to sign (STEP I) when all working conditions specified are complied with

and the worksite is safe to commence work.

SECTION 5 - WORKSITE PREPARATION / PRECAUTIONS (To be filled by AA)

G PRECAUTION TAKEN BY AA H CONDITION TO BE IMPLEMENTED BY RA / WL

Tagging Running Water On Secure Tools/Materials against Falling
Eqmt/Line Drain/Depressurise/Purge Lock Out and Tag Out Contact Area/Panel Operator/GCC before work start
Valves Isolation Barricade and WarningSign Contact Area/Panel Operator/GCC on completion
Flush with Water Scaffold Erected and Safe to be Used To be Accompanied by Area Operator / AGT
Valve Chain Locked Open/Close Equipment/Line Spaded as per List Others........................................................

Internal

PTW – Section 5 … cont

Joint Site Visit by RAR and AAR

 As specified by AA, AAR and RAR it is compulsory jointly conduct worksite inspection to
check readiness of worksite preparation and implementation of conditions an precautions
as specified in previous Sections.

 When all working conditions specified are complied with and the worksite is safe to
commence work, RAR and AAR to sign (STEP L)

 During joint site AGT to conduct initial gas test (AAR may also be an AGT)

Internal

PTW - HWAA

HOT WORK CONDITIONS SPECIFIED BY HWAA.

 Specify additional hot work requirements to be implemented by RA/WL.
 Determine Fire Watchers as standby persons for the work.
 Determine the types of gas tests, gas test frequency and mode of monitoring.
 To endorse the hot work requirements by signing (STEP K).

I CONDITIONS TO BE IMPLEMENTED BY RA / WL

Remove Flammable Material Fire Hose Spark Arrestor Cover sewer / drain / sump
Remove Combustible Material Fire Blanket N2 or Steam Purge Locate spark producing eqpmt. away from sewer / trench / pipe rack
Fire Extinguisher Fire Retardent Screen Hot Tapping Procedure Attached Others : Specify............................................

Fire Watch Name 1).......................................................................................... 2)........................................................................................................

J GAS TEST REQUIREMENT (To be filled by HWAA)

LEL Check Before Work Starts / After Break Every .......................... Hours Interval Continuous Gas Monitoring
Every .......................... Hours Interval Operator On Standby
H2S Test Before Work Starts / After Break Every .......................... Hours Interval No Venting or Draining of Hydrocarbon
within 10 metres Radius.
Oxygen Test Before Work Starts / After Break

Special Precautions ...........................................................................................................................................................................................................................................................

...........................................................................................................................................................................................................................................................................................

...........................................................................................................................................................................................................................................................................................
This permit is approved provided the above conditions and precautions are implemented.

K Hot Work Approving Authority Signature Department Designation Date

Internal

PTW – GAS TEST REQUIREMENT

INITIAL GAS TEST RESULT

 Gas test shall be carried out by an Authorized Gas Tester (AGT)
 Initial gas test shall be conducted prior to approval of hot work activity and for confined space

entry, the initial gas test taken before approving confined space entry certificate.
 Initial Gas Test must be conducted as closed as possible to the time of work activity.
 Maximum duration between initial gas test and start of hot work is one (1) hour.
 For confined space first entry, maximum duration between initial gas test and work start is half

(0.5) an hour.
 Subsequent gas tests shall be done in accordance with the frequency specified by the Hot Work

or Confined Space Entry Approving Authority

M INITIAL GAS TEST RESULT ( To be filled by AGT )

Test Standard Initial Result Request for initial gas test for confined space entry by CAA

Oxygen 19.5 % to 22 % Name : ................................................................................. Signature : ................................................
Combustible < 10 % LEL
Toxic Not more than PEL I have conducted the initial gas test and satisfy that the work requested can be carried out as approved.
T1
T2 AGT Name : ............................................................................................. Staff No :
............................
Signature :........................................................ Date :.................................. Time : .......................

Internal

Occupational Exposure Limits and Gas Measurements

Gas Test Working in a Working outside a
Confine Space Confined Space
Oxygen
Combustible 19.5% to 22% 19.5% to 22%

Toxic < 1% LEL < 10% LEL

< 50% PEL < PEL

Internal

PTW – Gas Test Renew

Hot Work Permit - Flowchart & Gas Test Table

Date O2 LEL Toxic Name Signature Remark Date O2 LEL Toxic Name Signature Remark RESPONSIBILITY HOT PTW FLOW CHART INTERFACING
Time Time RA/WL AA
ACTIVITY
RA/WL WORK DESCRIPTION & AA
SPECIFY TYPE OF HOT WORK

IDENTIFY OF HAZARDS
IDENTIFY PPE

IDENTIFY SUPPORTING DOCUMENT

APPLY CERTIFICATES & YES CERTIFICATE
GET APPROVAL REQUIRED ?
RA/WL AA
NO

RA ENDORSEMENT BY RA WL
RA/WL
AA 1. SPECIFY PRECAUTION & CONDITION
Date O2 LEL Toxic Name Signature Remark Date O2 LEL Toxic Name Signature Remark TO BE IMPLEMENTED AA
Time Time HWAA 2. REQUIREMENT FOR JOINT SITE VISIT

AAR & RAR SPECIFY HOT WORK CONDITIONS AA
AGT & GAS TEST REQUIREMENT & RA/WL
AA APPROVAL

PERFORM SITE VISIT &
INITIAL GAS TEST

APPROVAL

WL EXECUTE WORK RA/AAR
DISPLAY PTW AA
AA
WORK NO YES
COMPLETE ?
Date Date RA/WL REVALIDATE
Time Time RA/WL YES NO

HANDBACK APPLY NEW HOT
PTW

O2 LEL Toxic Name Signature Remark O2 LEL Toxic Name Signature Remark

RESPONSIBILITY CONFINED SPACE ENTRY FLOW CHART INTERFACING
AAR ACTIVITY AA
AGT
CAA PURGING / VENTILATION RA/AA
AAR
CAA ANALYZE FOR O2, LEL, TOXIC GAS
AGT CAA
CAA NO NO RA / RAR /WL

Note : RESPIRABLE ? EXHAUSTIVE
1. Permit is invalid if plant is declared on emergency and require newgas test once the plant declared All Clear subjected PURGING ?
YES
to AA approval. YES
HARMFUL /
Date O2 LEL Toxic Name Signature Remark
Time IRRESPIRABLE
*APPROVAL BY HIGHER

CAA

AGT TO SIGN

IMPLEMENT ALL SAFETY CONDITIONS
CERTIFICATE APPROVED

Internal

PTW – Section 6

APPROVAL.

 RA/RAR will endorse if he agreed with work site preparation has been completed and all precautions
specified in the permit have been implemented.

 AA will approve the permit when all requirements are met.
 RA/RAR shall brief WL on the Work Permit requirements.
 WL will sign upon understanding and agreeing his duties and responsibilities specified in Work Permit.
 The original (white copy) of the approved work permit to be displayed at worksite.
 Copy no. 1 (yellow copy) to be kept in control room/AA office.
 Copy no. 2 (pink copy) to be kept by RA/WL.

SECTION 6 - APPROVAL O APPROVING AUTHORITY (AA) P AGREEMENT BY WORK LEADER (WL)

N RECEIVING AUTHORITY (RA) / RA REPRESENTATIVE

Name : Date : Name : Date : Name : Date :
Signature : Time : Signature : Time : Signature : Time :

Internal

PTW – Section 7

REVALIDATION.

 When the work permit expires, all work activities must stop until revalidation endorsed
 Whenever the Work Permit required to be extended, WL will collect all copies of the permit

and bring back to control room or AA Office.
 RA/WL and AA shall sign for revalidation at every shift cycle or 12 hours duration.
 Gas Test must be taken whenever revalidation of Work Permit
 Only RA/RAR can be revalidated the permit
 However, for Confined Space Entry. The Hot Work Permit to Work is only valid for

maximum 12 hours.

Q SECTION 7 - REVALIDATION

TIME RA / WL Initial AA TIME RA / WL Initial AA Initial
DATE Name Name Initial Start Stop Name Name

Start Stop

Internal

PTW – Section 8

HAND BACK.

 For suspension of work, the Work Permit must be withdrawn immediately and brought to control room

or AA Office. AA must be notified on work stoppage.
 Once the work completed WL shall complete Section 8 to describe to condition of worksite.
 RA will endorse the closure of Work Permit.
 The Work Permit shall be taken to Control Room or AA Office for approval of closure by AA.
 If the work is not completed RA/RAR/WL shall notify AA on the status of the work and collect all copies

for revalidation or closing.
 All Work Permit shall be closed within 24 hours of work completion
 After 48 hours of incomplete/suspended work without any activity at work site, PTW will be

automatically invalid and shall be closed by handing back to RA and AA.

R SECTION 8 - HAND BACK ( To be filled by WL/RA ) (( PPTTWW ttoobbeecclolosseeddwwitihtihnin2424hohuorusruspuopnownowrkocrkomcoplmetpiolentioornpoerrmpietremxpitiry )
expiry )
Incomplete hand-back. ( equipment status, reason for hand-back, etc.) Work completed Housekeeping completed

Remarks :

Name : ENDORSED BY RA T ACCEPTED BY AA
Signature : Date : Date :
Time : Name : Time :
Signature :

Internal

Sharing on PTW
PERMITS SAVE LIVES -
GIVE THEM PROPER ATTENTION

Internal

Internal

PTW with Issues No.1

The Permit to Work was apply for 7
days work. However, was not
closed after 7 days

Internal

PTW with Issues No.2

The Permit to Work was apply for 7
days work. However, Revalidation
was only done for 3 days and the
PTW was close more than 48 hours

Internal

PTW with Issues No.3

Hot Work Permit to Work with
Flammable Material as hazard.
However, Fire Watcher was not

assign for the job.

Internal

Internal

CERTIFICATE

Certificates
Is a written and signed statement that specified checks or tests
have been carried out by an authorized person and that
conditions are acceptable. Certificates do not replaced the PTW
but are complementary.
 Is a formally supportive document issued against dedicated

Permit-to-Work (No: C/H 12345)
 A checklist items to be critically evaluated and ticked.
 Closure on job completion/clearing the area signed, date,

time, return to issuer.

Internal

CERTIFICATE

 All certificates are used as part of the Permit to Work System.
 Certificates are checklist which complementary to Permit to Work
 For Normal Certificate the maximum validity/life period is seven days

whereas for Special Certificate the maximum validity/life period could
be extended to the maximum period of three (3) months.
 The Special Certificate is required to be revalidated every seven (7)
days.

Internal