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    Supporting Document Title: Job Permit Form

    Uploaded by

    Redzwan Kadir
    This document outlines a job permit form used to manage high and low risk jobs. The form requires information such as the job title and scope, location, estimated start and completion times, applicant details, team members involved, and a job safety analysis. It is a 2-page form that is used to plan and authorize jobs, ensure safety requirements are met, and provide emergency contact information. Permits are valid for a maximum of 1 year for contractors who submit an HSE plan and can be checked by issuing officers on site.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Supporting Document Title: Job Permit Form

    Uploaded by

    Redzwan Kadir
    348 views2 pages
    This document outlines a job permit form used to manage high and low risk jobs. The form requires information such as the job title and scope, location, estimated start and completion times, applicant details, team members involved, and a job safety analysis. It is a 2-page form that is used to plan and authorize jobs, ensure safety requirements are met, and provide emergency contact information. Permits are valid for a maximum of 1 year for contractors who submit an HSE plan and can be checked by issuing officers on site.

    Original Title

    PTP_HSE_JOB_PERMIT

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    This document outlines a job permit form used to manage high and low risk jobs. The form requires information such as the job title and scope, location, estimated start and completion times, applicant details, team members involved, and a job safety analysis. It is a 2-page form that is used to plan and authorize jobs, ensure safety requirements are met, and provide emergency contact information. Permits are valid for a maximum of 1 year for contractors who submit an HSE plan and can be checked by issuing officers on site.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    348 views2 pages

    Supporting Document Title: Job Permit Form

    Uploaded by

    Redzwan Kadir
    This document outlines a job permit form used to manage high and low risk jobs. The form requires information such as the job title and scope, location, estimated start and completion times, applicant details, team members involved, and a job safety analysis. It is a 2-page form that is used to plan and authorize jobs, ensure safety requirements are met, and provide emergency contact information. Permits are valid for a maximum of 1 year for contractors who submit an HSE plan and can be checked by issuing officers on site.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Document No.

    FM-HSE-801-003
    Revision No. 003
    Effective Date 23 JULY 2018
    SUPPORTING DOCUMENT Page 1 of 2
    TITLE: JOB PERMIT FORM
    PART A : JOB PERMIT REFERENCE NUMBER: JP
    1) JOBS TITLE Low Risk Jobs High Risk Jobs
    a) Maintenance a) Working at height
    b) Inspection / survey b) Confined space
    2) COMMENCEMENT OF JOBS DATE: / / , TIME: HRS c) Troubleshooting c) Hot work
    d) Waste collection d) DG handling
    3) ESTIMATED COMPLETION DATE: / / , TIME: HRS e) Civil works e) Lifting activities
    f) Mobilization f) Lashing
    4) LOCATION g) Ship chandelling g) Electrical
    h) Device installation h) Excavation > 1.5m
    5) JOBS SCOPE DETAIL i) Cleaning i) Desludging /
    j) Others (specify): bunkering
    j) Others (specify):
    ______________________ _______________________

    ______________________ _______________________
    (Requires Permit To Work )

    PART B : STATEMENT OF UNDERTAKING

    6) PERMIT APPLICANT NAME & NRIC NRIC:

    7) DATE & TIME OF APPLICATION DATE: / / , TIME: HRS Checklist (filled by issuing officer on site)
    1. Safety briefing ( )
    8) CONTACT NUMBER & E-MAIL 2. Wear appropriate PPE ( )
    3. Barricade work area ( )
    9) DECLARATION
    4. Emergency procedure ( )
    5. First aid kit ( )
    On behalf of (company name) ________________________________________________ 6. Safety signage ( )
    declared that I fully understand all the safety requirements and instructions given by 7. Lock out / Tag out (LOTO) ( )
    PTP. I hereby take full responsibility for the safety and well being of all person that might be 8. Publish job permit / PTW ( )
    directly or indirectly affected / involved by and in this project (project title) 9. PMA/PMT attached ( )
    10. Competency certificate ( )
    ___________________________________________________________________________ 11. HSE Plan submitted ( )
    I shall, while undertaking and executing the project, at all time ensuring full compliance to all
    safety, health and environment rules, verbal or written instructions, apart from given Do’s & Don’ts for driver
    contractually, given by PTP officer from time to time without prior notice, I shall ensure that at 1. Wear seat belt ( )
    2. Keep headlights on ( )
    no time, any activity, action and event with relation to our project or employees in the project 3. Place beacon light ( )
    shall not disrupt or cause delay to the port operations. 4. Obey speed limit / signboard ( )
    5. Avoid using hand phone ( )
    PERMIT APPLICANT SIGNATURE 6. Parking at designated area ( )
    & COMPANY STAMP 7. Follow the traffic flow ( )
    8. Give way to RTG in yard ( )

    10) TEAM MEMBERS NAME NRIC / PASSPORT MAN HRS CONTACT NUM
    SITE MANAGER
    SAFETY IN CHARGE
    WORKER 1
    WORKER 2 Provide attachment if
    total of workers are
    WORKER 3 more
    WORKER 4
    WORKER 5

    11) VALIDITY (filled by issuing officer) 12) ISSUING OFFICER


    NAME :
    This permit is issued to _______________________________________ DESIGNATION :
    DATE & TIME :
    from ____/____/______,_______hrs to ____/____/______,______hrs
    subject to the compliance agreed upon by the applicant stated in the SIGNATURE :
    Statement of Undertaking by the contractor. & STAMP

    Maximum validation for 1 year for contractor that have submitted the
    Emergency Contact Number : +607-504 2203
    HSE Plan. For enquiries kindly refer to PTP HSE Department office
    HSE Officer On Duty : +6019-777 6841
    at +607-5042222 ext 5515 / 7732
    Document No. FM-HSE-801-003
    Revision No. 003
    Effective Date 23 JULY 2018
    SUPPORTING DOCUMENT Page 2 of 2
    TITLE: JOB PERMIT FORM

    PART C : JOB SAFETY ANALAYSIS (JSA) JP

    JOBS TITLE
    SEQUENCE OF JOB STEPS HAZARDS CONTROL MEASURE

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