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PTW Guidelines for Contractors

This document is a request for a permit to work from a contractor for work taking place at the PLTG 75 MW Paya Pasir Medan power plant from September 1-7, 2016. The request provides details of the work, proposed isolations and precautions, and attachments including a HIRAC analysis and method statement. It requires sign off from the owner's competent person as well as representatives from site safety and environmental teams to approve and issue the permit to work.

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Dimas Dwi Swarna
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1K views2 pages

PTW Guidelines for Contractors

This document is a request for a permit to work from a contractor for work taking place at the PLTG 75 MW Paya Pasir Medan power plant from September 1-7, 2016. The request provides details of the work, proposed isolations and precautions, and attachments including a HIRAC analysis and method statement. It requires sign off from the owner's competent person as well as representatives from site safety and environmental teams to approve and issue the permit to work.

Uploaded by

Dimas Dwi Swarna
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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PLTG 75 MW PAYA PASIR MEDAN

Request for Permit To Work (PTW) - Contactor

APPLICATION To be completed by Work Requestor and submitted to the


owner five (5) days before work start date .
Work to Date: 1/9/2016 - Work to
commence: 7/9/2016 Time: 08.00 - 17.00 complete : New Extend
Equipment/Apparatus or Work Area identification (KKS ID is compulsory)

Details of work (include drawing if necessary) Punchlist / Warranty / Others? ………………………………………

Propose required isolations and/or precautions, if known:

Person in charge of work


Name Company Contact Details Work team undergone safety induction
YES NO

ATTACHMENTS:
HIRAC analysis (required for non-routine & high risk works)
For PTW office Use
HIRAC approved by Contractor's Safety? YES NO
HIRAC from completed & attached? YES NO Type of doc: PTW / Access cert
Are there other assessments attached? Nisoft Ref. …………………………………
Confined Space:- YES NO Status: Rejected / Approved
Hot Work:- YES NO Reason: ………………………………..
Material Safety Data Sheets:- YES NO Remarks:
Other:- YES NO
Method Statement / Procedure (required for non-routine & high risk works)
Method Statement / Procedure approved YES NO
Method Statement / Procedure attached YES NO
Acknowledgement of receipt by Owner's Competent Person

Name: Signature: Date:

Competent Person
PERMIT TO WORK (PTW)

SPV PP HSE PP SEM PP EHS GE SITE PLN BATAM


REPRESENTATIVE
NAME

SIGNATURE

DATE

DAY / DATE SPV PP HSE PP SEM PP EHS GE SITE PLN BATAM


REPRESENTATIVE

PLN BATAM
SPV PP HSE PP SEM PP EHS GE SITE
REPRESENTATIVE
NAME

SIGNATURE

DATE

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