EMERGENCY TELEPHONE NUMBER: _________

CONTINUATION #: SIPP #:
SCHEDULE OF WORK ACTIVITY: START: (date/time) FINISH: (date/time):
PROJECT / TOOL NAME: ___________________CONTRACTOR: Print________________________________________

PROBABILITY OF OUTAGE OR RISK TO: MNx BLDG. [ 1 ][ 2 ][ 3 ][ 4 ][ 5 ] CVx [1] [2] [4]
WORK BEING PERFORMED AT: (Please check multiple areas, locations and levels as necessary)
Area/Building: MNx Bldg. [1] [2] [3] [4] [5] JMBC [ ] CVx [1] [2] [4]  Utility Bldg.  Other: _______
Location of Work:  RODI  AHU RM  Elect. Rm  Chiller Rm  CIGI  AWN Rm
 UPS/PLC Bldg./Rm  Grid/Col#’s:  Other: ________
Level of Work:  Roof  Basement  1 Fl  2 Flr  3 Flr  4 Flr
st nd rd t
 5 Flr  6Flr 
Other_____________

SIPP REQUESTER (Print): INTEL OWNER:

PRIMARY POINT OF CONTACT: PHONE/PAGER:
SECONDARY POINT OF CONTACT: PHONE/PAGER:
PREJOB BRIEFING AND SIGNING OF WORK PLAN MUST BE COMPLETED PRIOR TO COMMENCING WORK
DESCRIPTION OF WORK:

EXISTING SERVICE(S) AT RISK: (see below and circle or identify all affected):
AIR HANDLERS DRAIN: FMS / BMS MDA TELEPHONES
BCDS ELECTRICAL: GASES BULK NETWORKS VACUUM
CDA / OFA EXHAUST: GASES INERT PAGING SYSTEM VESDA
CHILLERS EMERGENCY PHONES GASES SPECIALTY PCW WATER:
COMMUNICAITONS EMERGENCY SHOWERS HUMIDIFICATION RODI OTHER:
DEHUMIDIFICATION EVAC SPEAKER/STROBE KITCHEN SATELLITE LINK
DUMBWAITERS/ELEV FIRE PROTECTION MAKE-UP AIR SIMPLEX

CHECK BOX FOR REQUIRED ATTACHED FORMS:

( ) CHEMICAL USE APPROVAL FORM ( ) EXCAVATION PERMIT ( ) SCAFFOLD PERMIT
( ) CONFINED SPACE PERMIT ( ) FIRE/LIFE SAFETY SYSTEMS PERMIT ( X) WORK PLAN/TEST PLAN
( ) CRITICAL LIFT PLAN ( ) HOT WORK OPEN FLAME PERMIT ( ) OTHER______________
( ) ECP PERMIT (Mech’l , Elec’l, etc.) ( ) INTERSTITIAL WORK PERMIT ( ) BARRIER TAPE OWNERSHIP FORM
( ) ENERGIZED ELECTRICAL WORK PERMIT ( ) MEWP (Mobile Elevated Work Platforms)
( ) ELECTRICAL PANEL SCHEDULES ( ) ODOR NOTIFICATION

SAFETY EQUIPMENT REQUIRED: (Shepherd’s Hook, Fire Extinguisher, Fall Protection, Safety Glasses, Hard Hats, Safety Boots)

SPECIAL EQUIPMENT/TOOLS: (welders, torch, forklift, scaffolds, mixer, core drill, generators, backhoe, cranes, etc.)

NOTIFY:  SECURITY COMMAND CENTER

SIPP INSTRUCTIONS / COMMENTS:

SIPP REQUESTER: (SIGN): TELEPHONE: DATE:

SIPP TECHNICIAN: (SIGN): TELEPHONE: DATE:

SIPP AUTHORIZER: (SIGN) TELEPHONE: DATE:

Rev. 0, 25/06/99
 PRE-TASK PLANNING WORK SHEET
(Required for all SIPP Matrix work not covered by an approved written procedure.)
Intel Work Owner: ______________ Telephone # : _____________ Pager #: ___________
Work Plan Author: ___________________ Telephone # : _____________ Pager #: ___________
Organization: ______________________ Start Date: ____________ Finish Date: ____________
Specific Location of Work: ____________________________________________________________
System Affected: __________________________ Equipment Affected: _______________________
Task to be
Performed:________________________________________________________________
________________________________________________________________

Important !
All contractors must have attended Contractor Safety Orientation prior to starting work.
Locations of exits and emergency equipment must be communicated to all workers prior to
starting work.
All workers must review, understand, and sign the work plan prior to starting work.
MSDS’s must be available in the work area for all chemicals used.

Any questions with a “Yes” answer must be addressed in the Work Plan
Will task require working on or around live systems or equipment? (mechanical, Yes No
electrical, chemical, pneumatic, hydraulic, etc.)
Will any additional emergency equipment be needed to complete this task safely? Yes No
(extinguisher, portable eye wash/shower, radios/phones, etc.)
Does the Area Supervisor need to be notified of the work to be done? Yes No
Does the work plan need to be coordinated with other crafts in the area? Yes No
Are shop drawings, panel schedules, or as-builts needed to complete this task? Yes No
Does this task require special training or licenses? (respirator, confined space, forklift, Yes No
crane, interstitial etc.)
Will the task involve any hot work? Yes No
Will weather or other working conditions affect the safe completion of this task? Yes No
Will you need special tools or equipment to perform the task safely? (scaffolds, lifts, Yes No
jacks, nets, cranes, etc.). If so, list in Work Plan.
Will this task generate hazardous waste or material? Yes No
Will this task impact the operation or effectiveness of any pollution prevention systems Yes No
Will the task involve the removal or disturbance of asbestos, lead, or arsenic? Yes No
Will the task produce dust, vapors, fumes, mists, odors, noise, and/or vibration? Yes No
Will any workers be required to work at heights above 6 feet? Yes No
Will the task create any risk of interruption to A/T Yes No
Will any work be performed under raised floor tiles? (If yes, see Pre-Entry Checklist) Yes No
Will lifting equipment or mobile elevated work platforms (MEWPs) be used? Yes No
Will the task create hazards to people working above, below, or around the work area? Yes No
Will the task affect perimeter security, violate security guidelines, or require the Yes No
addition/deletion of security equipment?

Check ALL PPE, permits, forms, and checklists required and address in the Work Plan

Rev. 0, 25/06/99
Permits:  SIPP  ECP  Hot Work  Scaffold  EEW  Excavation
 Confined Space  Interstitial Work  LSS/Yellow Card
 Other _________________

Forms:  Odor Notification  Chemical Use Approval  Panel Schedules

 Emergency SIPP Request  Critical Lift Plan  Barrier Tape Ownership
 Other __________________________

Checklists:  Mobile Elevated Work Platform (MEWP)

 Other _________________

PPE Req’d:  Hearing Protection  Eye/Face Protection  Foot Protection

 Head Protection  Full Body Protection  Hand/Arm Protection
 Fall Protection  Respiratory Protection  Other _________________

Contact EHS if assistance is needed in completing this work review or work plan
SIGNATURES:

Intel Work Owner ________________________________ Date: _____________

(Signature over printed name)
System Engineer ___________________________________ Date: _____________
(Signature over printed name)

___________________________________ Date: _____________

(Signature over printed name)
(required if any site system is impacted)

Area Supervisor ____________________________________ Date: ______________

(Signature over printed name)

____________________________________ Date: _____________

(Signature over printed name)

____________________________________ Date: _____________

(Signature over printed name)
(where applicable)

Rev. 0, 25/06/99
 WORK PLAN
Project Name: _________________ Start Date: _________________ Finish Date: ________________

Task to be accomplished (Mga

dapat gawin)
Steps To Take To Complete Task Hazards Required Actions To Eliminate Or
Control The Hazard

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

This Work Plan must be reviewed with all workers involved prior to starting any work.
Work Supervisor: _______________________________Petsa: ________________
Mga Manggagawa: _____________________________Petsa: ________________
_______________________________Petsa: ________________
_______________________________Petsa: ________________

Pre-Task Plan FOR Electrical Works

PRE-TASK PLANNING WORK SHEET
 (Required for all SIPP Matrix work not covered by an approved written procedure.)
Intel Work Owner: ______________ Telephone # : _____________ Pager #: ___________
Work Plan Author: ___________________ Telephone # : _____________ Pager #: ___________
Organization: ______________________ Start Date: ____________ Finish Date: ____________
Specific Location of Work: ____________________________________________________________
System Affected: __________________________ Equipment Affected: _______________________
Task to be
Performed:________________________________________________________________
________________________________________________________________

Important !
All contractors must have attended Contractor Safety Orientation prior to starting work.
Locations of exits and emergency equipment must be communicated to all workers prior to
starting work.
All workers must review, understand, and sign the work plan prior to starting work.
MSDS’s must be available in the work area for all chemicals used.

Any questions with a “Yes” answer must be addressed in the Work Plan
Will task require working on or around live systems or equipment? (mechanical, Yes No
electrical, chemical, pneumatic, hydraulic, etc.)
Will any additional emergency equipment be needed to complete this task safely? Yes No
(extinguisher, portable eye wash/shower, radios/phones, etc.)
Does the Area Supervisor need to be notified of the work to be done? Yes No
Does the work plan need to be coordinated with other crafts in the area? Yes No
Are shop drawings, panel schedules, or as-builts needed to complete this task? Yes No
Does this task require special training or licenses? (respirator, confined space, forklift, Yes No
crane, interstitial etc.)
Will the task involve any hot work? Yes No
Will weather or other working conditions affect the safe completion of this task? Yes No
Will you need special tools or equipment to perform the task safely? (scaffolds, lifts, Yes No
jacks, nets, cranes, etc.). If so, list in Work Plan.
Will this task generate hazardous waste or material? Yes No
Will this task impact the operation or effectiveness of any pollution prevention systems Yes No
Will the task involve the removal or disturbance of asbestos, lead, or arsenic? Yes No
Will the task produce dust, vapors, fumes, mists, odors, noise, and/or vibration? Yes No
Will any workers be required to work at heights above 6 feet? Yes No
Will the task create any risk of interruption to A/T Yes No
Will any work be performed under raised floor tiles? (If yes, see Pre-Entry Checklist) Yes No
Will lifting equipment or mobile elevated work platforms (MEWPs) be used? Yes No
Will the task create hazards to people working above, below, or around the work area? Yes No
Will the task affect perimeter security, violate security guidelines, or require the Yes No
addition/deletion of security equipment?

Interstitial works for

Electrical conduiting, wiring
 PTP / WORKPLAN
Project Name: _ Start Date: _____________ Finish Date: ______________

Task to be accomplished
Steps To Take To Complete Task Hazards Required Actions To Eliminate Or
Control The Hazard

Notify concerned parties of the project Miscommunication Notify intel owner of work, systems engineer and
area supervisor.

Mobilization of necessary tools, Struck by / against Proper handling of materials.

equipment and materials.
Install interstitial devices such as lifelines, Fall / slip
plankings and floodlights Physical injury
Struck existing utilities
Install lock out tag out devices Accidental opening of live
lines
such as breakers
Electrocution
Installation support and brackets Fall / slip
To be bolted part by part at c-purlins. Eye injury
Hand injury
Lifting of pipes & lay out of conduits Struck existing utilities
Installation and knock out of pull boxes (live valves & wires)
(chipping of wall for conduit penetration)
Installation of manifolds, panel boards , co’s laceration
Cable pulling/roughing ins Fall\slip
Follow 8-ft. rule when handling long materials.
Install barricades. Wear PPE’s
Wear full body harness
Conduct inspection above interstitial for possible
hazards. Assign interstitial trained personnel
Follow lock out-tag out procedures
Proper coordination with systems
Verify residual energy
Wear full body harness , PPE’s ,Wear gloves
Proper handling of materials.
Use of pulley or rope to lift materials.
Assign watchman
Install barricade below overhead/interstitial works.
Have an approval from structural engineer
Use telescopic ladder
Wear gloves, body harness
Have buddy at ladder.

Termination of wires to panels and eqpt. Hand & eye injury Wear cotton gloves , PPE’s
Electrocution Install individual Lo|to at panel ckt. breakers
Laceration Only approved elec’l knife will be used
Testing and commissioning

De-installation of interstitial devices Slip / hand injury Pull out excess materials and garbage.
(planks, lifelines, tasklights) Wear gloves
General housekeeping Don’t leave debris in interstitial

This Work Plan must be reviewed with all workers involved prior to starting any work.
Bago umpisahan ang anumang trabaho, ang work plan na ito ay dapat masuri kasama ang lahat ng
manggagawa.

Work Supervisor: __________________________ Petsa: ________________

Mga Manggagawa: __________________________ Petsa: ________________
___________________________ Petsa: ________________
___________________________ Petsa: ________________

Pre-Task Plan FOR Mechanical Works

 PRE-TASK PLANNING WORK SHEET
(Required for all SIPP Matrix work not covered by an approved written procedure.)
Intel Work Owner: ______________ Telephone # : _____________ Pager #: ___________
Work Plan Author: ___________________ Telephone # : _____________ Pager #: ___________
Organization: ______________________ Start Date: ____________ Finish Date: ____________
Specific Location of Work: ____________________________________________________________
System Affected: __________________________ Equipment Affected: _______________________
Task to be
Performed:________________________________________________________________
________________________________________________________________

Important !
All contractors must have attended Contractor Safety Orientation prior to starting work.
Locations of exits and emergency equipment must be communicated to all workers prior to
starting work.
All workers must review, understand, and sign the work plan prior to starting work.
MSDS’s must be available in the work area for all chemicals used.

Any questions with a “Yes” answer must be addressed in the Work Plan
Will task require working on or around live systems or equipment? (mechanical, Yes No
electrical, chemical, pneumatic, hydraulic, etc.)
Will any additional emergency equipment be needed to complete this task safely? Yes No
(extinguisher, portable eye wash/shower, radios/phones, etc.)
Does the Area Supervisor need to be notified of the work to be done? Yes No
Does the work plan need to be coordinated with other crafts in the area? Yes No
Are shop drawings, panel schedules, or as-builts needed to complete this task? Yes No
Does this task require special training or licenses? (respirator, confined space, forklift, Yes No
crane, interstitial etc.)
Will the task involve any hot work? Yes No
Will weather or other working conditions affect the safe completion of this task? Yes No
Will you need special tools or equipment to perform the task safely? (scaffolds, lifts, Yes No
jacks, nets, cranes, etc.). If so, list in Work Plan.
Will this task generate hazardous waste or material? Yes No
Will this task impact the operation or effectiveness of any pollution prevention systems Yes No
Will the task involve the removal or disturbance of asbestos, lead, or arsenic? Yes No
Will the task produce dust, vapors, fumes, mists, odors, noise, and/or vibration? Yes No
Will any workers be required to work at heights above 6 feet? Yes No
Will the task create any risk of interruption to A/T Yes No
Will any work be performed under raised floor tiles? (If yes, see Pre-Entry Checklist) Yes No
Will lifting equipment or mobile elevated work platforms (MEWPs) be used? Yes No
Will the task create hazards to people working above, below, or around the work area? Yes No
Will the task affect perimeter security, violate security guidelines, or require the Yes No
addition/deletion of security equipment?
Interstitial works for

mechanical process piping

 PTP / WORKPLAN
Project Name: _FC FTO Interim Start Date: _____________ Finish Date: ______________

Task to be accomplished (Mga

dapat gawin)
Steps To Take To Complete Task Hazards Required Actions To Eliminate Or
Control The Hazard

Notify concerned parties of the project Miscommunication Notify intel ownerof work, systems engineer and
area supervisor.

Mobilization of necessary tools, Struck by / against Proper handling of materials.

equipment and materials.
Install interstitial devices such as lifelines,
plankings and floodlights
Install lock out tag out devices
Installation of pre-fab support and brackets
To be bolted part by part at c-purlins.
Installation of process piping
(PCW, N2, OFA and Vacuum)
Follow 8-ft. rule when handling long materials.
Install barricades. Wear PPE’s
Fall / slip Wear full body harness
Physical injury Conduct inspection above interstitial for possible
Struck existing utilities hazards. Assign interstitial trained personnel
Accidental opening of live Follow lock out-tag out procedures
lines
such as valves Proper coordination with systems
Use of telescopic ladder
Fall / slip Wear full body harness , PPE’s
Eye injury Proper handling of materials.
Use of pulley or rope to lift materials.
Struck existing utilities Assign watchman
(live valves) Install barricade below overhead/interstitial works.

Hand injury Wear gloves

Gas welding of copper pipes Burn / Fire Assign firewatcher. Provide fire extinguisher and
fire blanket.
Wear appropriate PPE for welding
Painting and gluing works of PVC piping Odor emission Follow odor protocol. Post odor notification at
nearby areas.
Read and understand MSDS contents.
Install intel supplied materials such as Hand & eye injury Wear cotton gloves , PPE’s
valves,
Gauges, hose, quick connect, thermometer
And fittings
Leak testing and commissioning Pressure drop Proper leak test procedure
Use section 15060 in spec for leak test 100 psi for
8 hours
De-installation of interstitial devices Slip Pull out excess materials and garbage.
(planks, lifelines, tasklights) Wear gloves
General housekeeping
This Work Plan must be reviewed with all workers involved prior to starting any work.
Work Supervisor: __________________________ Petsa: ________________
Mga Manggagawa: ___________________________________ Petsa: ________________
___________________________________ Petsa: ________________
___________________________________ Petsa: ________________

Pre-Task Plan FOR CIVIL Works

PRE-TASK PLANNING WORK SHEET
 (Required for all SIPP Matrix work not covered by an approved written procedure.)
Intel Work Owner: ______________ Telephone # : _____________ Pager #: ___________
Work Plan Author: ___________________ Telephone # : _____________ Pager #: ___________
Organization: ______________________ Start Date: ____________ Finish Date: ____________
Specific Location of Work: ____________________________________________________________
System Affected: __________________________ Equipment Affected: _______________________
Task to be
Performed:________________________________________________________________
________________________________________________________________

Important !
All contractors must have attended Contractor Safety Orientation prior to starting work.
Locations of exits and emergency equipment must be communicated to all workers prior to
starting work.
All workers must review, understand, and sign the work plan prior to starting work.
MSDS’s must be available in the work area for all chemicals used.

Any questions with a “Yes” answer must be addressed in the Work Plan
Will task require working on or around live systems or equipment? (mechanical, Yes No
electrical, chemical, pneumatic, hydraulic, etc.)
Will any additional emergency equipment be needed to complete this task safely? Yes No
(extinguisher, portable eye wash/shower, radios/phones, etc.)
Does the Area Supervisor need to be notified of the work to be done? Yes No
Does the work plan need to be coordinated with other crafts in the area? Yes No
Are shop drawings, panel schedules, or as-builts needed to complete this task? Yes No
Does this task require special training or licenses? (respirator, confined space, forklift, Yes No
crane, interstitial etc.)
Will the task involve any hot work? Yes No
Will weather or other working conditions affect the safe completion of this task? Yes No
Will you need special tools or equipment to perform the task safely? (scaffolds, lifts, Yes No
jacks, nets, cranes, etc.). If so, list in Work Plan.
Will this task generate hazardous waste or material? Yes No
Will this task impact the operation or effectiveness of any pollution prevention systems Yes No
Will the task involve the removal or disturbance of asbestos, lead, or arsenic? Yes No
Will the task produce dust, vapors, fumes, mists, odors, noise, and/or vibration? Yes No
Will any workers be required to work at heights above 6 feet? Yes No
Will the task create any risk of interruption to A/T Yes No
Will any work be performed under raised floor tiles? (If yes, see Pre-Entry Checklist) Yes No
Will lifting equipment or mobile elevated work platforms (MEWPs) be used? Yes No
Will the task create hazards to people working above, below, or around the work area? Yes No
Will the task affect perimeter security, violate security guidelines, or require the Yes No
addition/deletion of security equipment?

WORK PLAN FOR Painting \Civil Works

Task to be accomplished
Steps To Take To Complete Task Hazards Required Actions To Eliminate Or
 Control The Hazard

1. Survey the area of work Fall \ struck against Use of PPE’s

Hold ladder firmly
2. Notify area supervisor, system Miscommunication \ Proper information and coordination
engineers and other crafts in the area. Overcrowding of the area to all concerned persons.

3. Mobilization of tools and materials Might struck other person and Assign guide person
Equipment. Install Barricades

4. Conduct tool box meeting Miscommunication Conduct meeting on site prior to start
Read and sign on workplan
5. Barricade the area of work Struck others Isolate the area, post proper signs
Wear PPE’s
6. Application of patching compound Dizziness Wear mask and follow Odor form
( weather can affect the task) Slip \ fever protocol checklist.
Stop work if raining
Sanding of wall to smoothes Allergies Wear mask and other PPE’s
surface.
7. Application of paint to the walls Asthma and skin allergy Wear gloves and respirator
and doors. Post Odor notification forms
Provide CUA, MSDS
8. Removal of barricade after Conflict Coordinate properly \
appropriate curing of paint. Post Wet paint signs

9. Housekeeping and cleaning of the None None

affected areas.

This Work Plan must be reviewed with all workers involved prior to starting any work.
Work Supervisor: ___________________________________ Petsa: ________________
Mga Manggagawa: ___________________________________ Petsa: ________________
___________________________________ Petsa: ________________
___________________________________ Petsa: ________________
___________________________________ Petsa: ________________