PTW in PAVCSGTitle of the Job/ProjectAnnual Rack Safety InspectionDepartment/Location:Job requested by :Duration of the Job:Person-in charge:/Contact Number:Permit To Work in PAVCSGS/NSafety Document CheckYesNoRemarks1Method Statement2Risk assessment3Safe Work Procedure4Toolbox meeting form5Declaration of chemical useProvide SDS6Declaration of equipment/tools used7Permit to work system for Work at heightLicence for Work at Height for supervisor, MEWP ,Fall Protection Plan.8Permit to work system for HotworkLicense worker for conducting welding.9Permit to work system for Crane / HoistingLicence for Crane operator,Lifting supervisor,signallar,rigger.Lifting Plan.Certificate for crane and accessories used.10Permit to work system for confined spaceConfined space accessor,11Apply Lock out tag out procedureLEW, Portable ELCB.12Legalize worker checked13Emergency Response Chart/ Org, ChartProvide own 1st aid box and standby own fire extinguishers14PPE Provided15Licence workers/equipment.Licence required :ForkliftNote: Only with this approved document is allowed to work in PAVCSG.

anthony.poo:What is your project activities in PAVCSG?anthony.poo:Where is the location and which department involve?anthony.poo:Job should be requested by the contractorsanthony.poo:How many days of work?anthony.poo:Contractor's supervisor in charge and contact number?Checked By FSGChecked by Process OwnerApproved ByWSHO/ManagementDate

Use of equipmentList of items used (Facilities) in PAVCSGUse of equipment/machinesRemarks1234567891011121314151617181920212223242526272829303132333435Signature

Chemical usedList of items used (Chemicals) in PAVCSGUse of chemicalsSDSRemarks1234567891011121314151617181920212223242526272829303132333435Signature