RAMATEX POLYESTER WORK PERMIT WP NO :

SECTION A : PERMIT REQUIRED FOR (PERMIT DIPOHON UNTUK)

COLD WORK HOT WORK HIGH WORK CONFINED SPACE / VESSEL ENTRY X OTHERS CHILLER
(KERJA SEJUK) (KERJA PANAS) (KERJA TEMPAT TINGGI) (RUANG TERKURUNG) (LAIN-LAIN)

SECTION B : JOB INFORMATION (MAKLUMAT PROJEK)

JOBS DESCRIPTION MENUKAR MINYAK CHILLER TAHUNAN
(KETERANGAN PROJECT)
WORK LOCATION POY / CHILLER SITE SUPERVISOR (POLYESTER STAFF/WORKER)
(LOKASI KERJA) (PENYELIA KAWASAN)
CONTRACTOR COMPANY NAME YORK NAME HAFIZUUDIN
(NAMA SYARIKAT KONTRAKTOR) (NAMA)
CONTRACTOR SUPERVISOR NAME AZLAN DATE 13.07.2019
JOB DETAILS

(NAMA PENYELIA KONTRAKTOR) (TARIKH)

CONTRACTOR S/V CONTACT NO. 012-2345678 CONTACT NO
(NO TELEFON PENYELIA KONTRAKTOR) (NO TEL)

SECTION C : NATURE OF WORK (JENIS PEKERJAAN)

WORK AT HEIGHT X SERVICING INSULATION/PAINTING FIRE ALARM SYSTEM
(KERJA TEMPAT TINGGI) (PENYELENGGARAAN) (MENEBAT/MENGECAT) (SISTEM PENGGERA KEBAKARAN)
WORK ON ROOF RADIATION SOURCES HOT WORK PIPELINE SEAK SEALING
(KERJA ATAS BUMBUNG) (SUMBER RADIASI) (KERJA PANAS) (MENAMPAL KEBOCORAN PAIP)
WELDING/GAS CUTTING CONFINE SPACE COLD WORK ELECTRICAL SYSTEM
(KIMPALAN/PEMOTONG GAS) (RUANG TERKURUNG) (KERJA SEJUK) (SISTEM ELEKTRIK)
LIFTING WORK EXCAVATION/ROAD REPAIR OPENING LINES/EQUIPMENT X OTHERS
(KERJA MENGANGKAT) (PENGGALIAN/BAIKI JALAN) (PEMBUKAAN PERALATAN) (LAIN-LAIN)

SECTION D : TOOLS & EQUIPMENT TO BE USED (PERALATAN YANG DIGUNAKAN)

WELDING MACHINE X LOCKOUT / TAGOUT PORTABLE ELECTRICAL TOOLS AIR/ HYDRAULICALLY OPERATED
(MESIN KIMPALAN) (KUNCI/PENANDA KUNCI) (ALAT ELEKRICAL MUDAH ALIH) ANGIN
VEHICLE / ORANE X LADDER CONFINED SPACE ENTRY NON-FLAMEPROOF EQUIPMENT
(KENDERAAN PENGANGKUT) (TANGGA) (PINTU MASUK RUANG TERKURUNG) PERALATAN TIDAK KALIS API
X NON-SPARKING TOOLS BARRICADE/HOARDING GAS SILINDER OTHERS
(ALAT BUKAN PERCIKAN API) (PAGAR/PENGHADANG) (SILINDER GAS) (LAIN-LAIN)
STRESS RELIEVING MACHINE FIRE BLANKET FIRE EXTINGUISHER OTHERS
(MESIN MELEPASKAN TEKANAN) SELIMUT KEBAKARAN ALAT PEMADAM API (LAIN-LAIN)

SECTION E : PPE & FIRE PROTECTION (ALAT PERLINDUNGAN DIRI)

X HAND GLOVE SAFETY HELMET RUBBER MAT SAFETY CLOTH
(SARUNG TANGAN) (TOPI KESELAMATAN) (ALAS GETAH) (PAKAIAN KESELAMATAN)
JOB PREPARATION & PPE REQUIREMENTS

BODY HARNESS X SAFETY SHOES RESPIRATOR/MASK LIGHTNING DETECTOR

(ABAH-ABAH KESELAMATAN) (KASUT KESELAMATAN) (TOPENG KESELAMATN) (PENGESAN PETIR)
EAR PROTECTION SAFETY NET FACE SHIELD WELDING APRON/SUIT
(PELINDUNG TELINGA) (JARING KESELAMATAN) (PELINDUNG MUKA) (BAJU KIMPALAN)
GOGGLE HI-VISIBILITY VEST OTHERS OTHERS
(CERMIN MATA KESELAMATAN) (VES PEMANTUL CAHAYA) (LAIN-LAIN) (LAIN-LAIN)
Note: Safety Shoes, Safety Helmet, Safety Goggles and the usage of regular / general PPE is mandatory in addition to above special PPE

SECTION F : HAZARD IDENTIFICATION (PENGENALPASTIAN HAZARD)

FIRE HAZARD PRESSURIZED OXYGEN DEFICIENT LIFTING INJURY
(TERBAKAR) (TEKANAN) (KEKURANGAN OKSIGEN) (CEDERA MENGANGKAT)
X FALL FROM HEIGHT HOT SURFACE TOXIC MATERIAL (SPECIFY) VEHICLE ACCIDENT
(TERJATUH DARI TEMPAT TINGGI) (PERMUKAAN PANAS) (BAHAN TERCEMAR) (KEMALANGAN KENDERAAN)
X ELECTROCUTION RADIATION HAZARDS X ERGONOMICS SLIP/TRIP/FALL
(RENJATAN ELEKTRIK) (RADIASI) (ERGONOMIC) (TERGELINCIR/TERSADUNG/JATUH)
DUST / FIBRES EXPLOSION COLLAPSE/TOPPLES OTHERS
(HABUK) (LETUPAN) (PENGSAN/RUNTUH) (LAIN-LAIN)

SECTION G : COMPETENCY REQUIREMENT (KEPERLUAN KOMPETEN)

COMPETENT WELDER CHARGE-MAN CRANE DRIVER FORKLIFT DRIVER
(PENGIMPAL BERTAULIAH) PEMANDU CRANE PEMANDU FORKLIF
BACKHOE DRIVER FIRE WATCH AUTHORIZED GAS TESTER METAL CUTTER/GRINDER
(PEMANDU JENTOLAK) (PENGUJI GAS BERTAULIAH) (PEMOTONG/PENGISAR)
SCAFFOLDING ERECTOR EXCAVATOR CONFINED SPACE PERSON OTHERS
(PEMASANG PERANCAH) (PENGGALI TANAH) (PEKERJA CONFINED SPACE) (LAIN-LAIN)

SECTION H : GAS TESTED RESULT (KEPUTUSAN UJIAN GAS)

TO BE FULL UP BY AUTHORISED GAS TESTER (AGT) GAS RESULT
(DIISI OLEH PENGUJI GAS YANG BERKELAYAKAN) (GAS) (KEPUTUSAN)
NAME O₂ %
(NAMA)
EMP. NO/I.C NO % LEL
(NO KERJA / K.P)
DATE H₂S PPM
(TARIKH)
TIME CO PPM
(MASA)
SIGN OTHER
(TANDA TANGAN)

SECTION I : PERMIT PERIOD (TEMPOH PERMIT)

PERMIT IS VALID FROM………………09:00…………...Hrs. UP TO………………19:00…………...Hrs. ON DATE………………13.07.2019……………
SECTION J : DECLARATION (PENGISTIHARAN)
DECLARATION & APPROVAL

I HEREBY CONFIRM THAT ALL MEASURES AS SPECIFIED ABOVE AND ALL INSTRUCTION STATED IN THIS WORK PERMIT WILL BE FOLLOWED.
(SAYA MENGAKU SEMUA PERKARA YANG DITULIS DIATAS DAN SEMUA ATURAN TERCATAT DI PERMIT KERJA INI AKAN DIIKUTI)
INTOLERABLE RISK SUBJECTED TO ANY VIOLATION OF THIS PERMIT'S REQUIREMENT MAY CAUSE WORK PROCESS BEING STOPPED.
(SEKIRANYA TERDAPAT AKTIVITI YANG BERTENTANGAN DENGAN KEPERLUAN PERMIT INI BOLEH MENGAKIBATKAN PROSES KERJA DIBERHENTIKAN)
PROJECT SUPERVISOR AUTHORISED PERSON
(PENYELIA PROJEK) (ORANG YANG DIBENARKAN)
NAME AZLAN NAME DATE TIME SIGN NAME DATE TIME SIGN
(NAMA) (NAMA) (TARIKH) (MASA) (T/TANGAN) (NAMA) (TARIKH) (MASA) (T/TANGAN)
POSITION SUPERVISOR BUDIN 13.07.19 8:00
(JAWATAN)
DATE 13.07.2019 DIMAN 13.07.19 8:00
(TARIKH)
TIME 8:00
(MASA)
SIGN
(TANDA TANGAN)

SECTION K : PERMIT APPROVAL (KELULUSAN PERMIT)

SAFETY AND HEALTH COMMITTEE PLANT MANAGER
(JAWATANKUASA KESELAMATAN & KESIHATAN) (PENGURUS KILANG)
THIS PERMIT IS √ APPROVED NOT APPROVED THIS PERMIT IS √ APPROVED NOT APPROVED

NAME EZZRY NAME GOH ONG MENG

(NAMA) (NAMA)
DATE 13.07.2019 DATE 13.07.2019
(TARIKH) (TARIKH)
TIME 8:00 TIME 8:15
(MASA) (MASA)
SIGN SIGN
(TANDA TANGAN) (TANDA TANGAN)

SECTION L : CLOSURE / CANCELLATION (PENUTUPAN / PEMBATALAN)

√ PERMIT IS CLOSED. JOB IS COMPLETE, HOUSEKEEPING IS RESTORED TO NORMAL
PERMIT DITUTUP. KERJA SUDAH SELESAI, KERJA PEMBERSIHAN TELAH DILAKUKAN.
PERMIT IS CLOSED. JOB IS CONTINUED, PLEASURE IS ISSUE A NEW WORK PERMIT
CLOSURE

PERMIT DITUTUP. KERJA AKAN DISAMBUNG, PERMIT BARU KANA DIBUKA.

PERMIT IS CANCELLED. PERMIT CANCELLED AS PRESENT CONDITION NOT CONDUSIVE FOR CARRYING THE WORK.
PERMIT DIBATALKAN. PERMIT DIBATALKAN, KEADAAN SEMASA TIDAK SESUAI UTNUK KERJA DIJALANKAN.
SITE SUPERVISOR (POLYESTER STAFF/WORKER) SAFETY AND HEALTH COMMITTEE
(PENYELIA KAWASAN) (JAWATANKUASA KESELAMATAN & KESIHATAN)
NAME HAFIZUDDIN NAME EZZRY
(NAMA) (NAMA)
DATE 13.07.2019 DATE 13.07.2019
(TARIKH) (TARIKH)
TIME 18:00 TIME 18:15
(MASA) (MASA)
SIGN SIGN
(TANDA TANGAN) (TANDA TANGAN)