Janardhan Janardhan

31.10.2021 31.10.2021
 Petro China (Halfaya) Permit To Work System
EXCAVATION CERTIFICATE No: 028

I. TASK
Brief description of the proposed task: Mechanical excavation for the OHTL &POS foundations (PL087-C/H6+Hx,PL088-C/H6+Hx) in HF168 Work Request Period (Planning)
From Date 13-10-2021 Time 7:00 am
To Date 12-11-2021 Time 5:00 pm
Work Permit Number: :PTW 52 Permit Type Hot Work Permit  Cold Work Permit
Location: HF-168 Excavation  Digging Wall Penetration
Name (Certificate Originator): Haitham Raheem Signature & Contact no: 07810550464 Date: 11-10-2021 Time: 9:00 AM
II. WORK TYPE

Yes No Yes No Supporting Documents YES NO Attached & Number

Trenching
 Driving of pickets, electrodes, pin,  Job Hazard Analysis
 JHA118
spike, pipe, nails, etc.
Drilling  Method Statement  Method Statement 01
Ground Ripping
 Demolishing
 Toolbox Talk
 TBT-120
Foundation
 Sawing
 Drawings
 HF0168- drawings

Post Holes
 Penetrating into walls
 SIMOPS

Other, specify:
 Other, specify:
 Other, specify:

III. DISCIPLINE AUTHORISATIONS

Discipline Engineer Conditions (if any) Name Signature Date

Raad Karee 11.10.21
Instrumentation
Control Systems Raad Kareem 11.10.21
Corrosion Underground facilities to be protected if found Janardhan 11.10.2021
Production Operations
Mechanical Ok as per attached drawing Ali Hasan 12.10.2021
Electrical Underground facilities to be protected if found Janardhan 11.10.2021
IT / Communications
Other, specify:

IV. GENERAL CONSIDERATIONS

Design Considerations YES NO HSE Considerations YES NO

All utilities and underground services identified and marked?
All underground services de-energised/de-pressurized and locked and tagged before
breaking ground?
Sloping, benching or support systems being used? Have these been approved by a
competent person (subject matter expert)?
Adequate access/egress provided (minimum every 7.6m / 25 feet)?
Is a soil compaction test required?
Does design, or soil conditions prevent cave-in? If not sloping benching shall be used?
Heavy / earth moving machinery is not to be used within 5m of underground
services, pipelines, etc.?
Spoil piles kept at least 2m from edge of excavation?
Stop logs' considered in high traffic areas to prevent vehicles falling into
excavation?
 PTWs required for all work in or around the excavation?

 Barriers erected around deep excavations to prevent personnel from falling in?

 Roads, pathways identified and barriers erected to manage vehicles and foot traffic?

 Warning signs erected near excavation sites? 
 Requirements for dailyinspections identified (or as conditions occur that may affect
or create hazards)?

 Will excavation be left open overnight? Provide covering, visible barriers or
warnings/lights to prevent personnel from falling in.

 Vehicles positioned to prevent exhaust fumes entering excavation? 
 Spoil and equipment positioned to prevent falling into excavation? 
 Spoil and equipment positioned to prevent falling into excavation?

Design prevents or minimises chance of water ingress?  Ventilation required? 

Adjacent structures identified and considered to prevent loss of stability?  Emergency response actions understood by all persons for all underground
services that may be expected?

V. SPECIALIST REVIEW (Civil Engineer) (To be determined by Permit or Certificate Issuing Authority)
Specialist Review Required? (circle as necessary) YES NO
Name : Signature: Contact no: Speciality:
Comments Date:
Time:
VI. CERTIFICATE APPROVAL AND ISSUANCE
PERFORMING AUTHORITY AREA OPERATOR / CUSTODIAN
I understand the work scope and accept the conditions and precautions specified in this certificate. I will
explain them to the work party through a toolbox talk prior to commencing the work and ensure I declare that all hazards have been identified and all specified control measures are in place and it is safe
adherence throughout the work. I fully accept the responsibility to carry out the above work in the safest to carry out the work defined.
possible manner.
Name: Wang Xinbao Name: Janardhan
Employee No.: Employee No.:
Signature: Signature:
Date / 11-10-2021/ 9:00 AM Date / Time: 12.10.2021
VII. CERTIFICATE EXTENSION / RENEWAL (For extended period, Additional Sheet For PCH Work Permit Extension may be attached to this certificate)
PERFORMING AUTHORITY AREA OPERATOR / CUSTODIAN
Date Time Name: Signature: Name: Signature:

VIII. CERTIFICATE CLOSURE

PERFORMING AUTHORITY AREA OPERATOR / CUSTODIAN
I declare that the work has been completed, worksite is clear, housekeeping is satisfactory and the I have inspected the equipment/work area and declare that the work defined in this certificate is complete
equipment affected is left in a safe condition. and that the area is clean and safe.
THE EXCAVATION CERTIFICATE IS NOW CLOSED
Name: Name:
Employee No.: Employee No.:
Signature: Signature:
Date/Time: Date / Time:
Top Copy: Performing Authority (To be displayed at job site) Second Copy: Permit Control Facility/CCR Third Copy: Permit Issuing Authority

NOTE: This certificate is valid only when used with a valid work permit. This certificate alone does NOT authorise any task to be performed. Version 2.1 Jan 01 2018
HF168

CLIENT:

PetroChina International Iraq FZE Iraq Branch

CONTRACTOR:
Power Petroleum International Co.,Limited
China Petroleum Engineering Co.,Ltd

PROJECT TITLE:

Provision of EPCC for Power Supply to

Well Pads (2020-2021)
DRAWING TITLE:

OHTL PLAN LAYOUT DRAWING

STAGE DRAWING NO. SHT. REV.

HF168
Appendix A:

JHA No: 113

JOB HAZARD ANALYSIS
Date: 14-10-2021
PetroChina (Halfaya)
Next Review Date /
Non-Routine Job/Task Routine Job/Task 13-11-2021
Valid till:

Reference: HFY-CON/F&C1048-
Location: HF168 Performing Agency: Power petroleum international
(WO /Project #) 1071/02-
PRID5141#
Job/Task Description

Mechanical excavation for OHTL & POS foundations in HF 168

Section / Section /
No. Name Position Signature No Name Position Signature
Contractor Contractor
4 Mustafa A. Hammod QCI PPI
1 Salih HSE PPI
Supervisor
5 Mohammed Jassim Site eng. PPI
2 Ali Kareem HSE PPI
Supervisor
Hayder R. QEC PPI 6
3

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 1
 Additio
nal
hazard / Residual risk level
Step Description of job/task step Hazards and Inherent risk level (Acceptable /
Hazard/risk controls already in place risk Action by (Acceptable / not
No. (what and where) threats / causes not Acceptable)
controls Acceptable)
recomm
ended
1- Warning tape instullation PPI Acceptable
1- Slips around the mainholels
inside 2- Warning sign in work place
1 Isolated work area Acceptable
main 3- Safety meeting for labors
holes working there about how
important the isolations
1- Isolated pads parts and no one PPI Acceptable
be closed to it
2- Inform all the staff about
Slip and sensitive of equipment inside
fall down Well Pads
Traffic 3- TBT meeting for the staff
accident before the work
2 Excavation Acceptable
Incident by 4- Safety meeting for the staff
excavator before the work
5- A watch man be in duty during
any work
6- Prevents any traffic move in
side Well Pads

1. Inform all the staff about PPI Acceptable

sensitive of equipment inside
Well Pads
Working inside or closed the 2. Keep safety distance from any
3 H2s risk
pads equipment inside the pads
3. Inform the supervisor about
any Doubt case

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 2
 Additio
nal
hazard / Residual risk level
Step Description of job/task step Hazards and Inherent risk level (Acceptable /
Hazard/risk controls already in place risk Action by (Acceptable / not
No. (what and where) threats / causes not Acceptable)
controls Acceptable)
recomm
ended
 Wear proper PPE for the PPI Acceptable
 Electrical work
 Finger injury
 Noise  Conduct TBT before work
 Hearing damage
 Rotating  Workers shall be competent
4  Cleaning, grinding  Eye damage
equipment for the work
 Skin irritation
 Sharp/harmful  Use right tools for the job
 Respiratory tract infection
contact  Check the tools before use
 Provide first aid kit

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 3
 Additio nal
hazard / risk
controls Residual risk level
Step Description of job/task step Hazards and Inherent risk level
Hazard/risk controls already in place recomm Action by (Acceptable / not
No. (what and where) threats / causes (Acceptable / not
ended Acceptable)
Acceptable)

 Obtain a valid work PPI Acceptable

permit before
starting any work
 Unauthorized
 Conduct Toolbox
work
Talk to all personnel
 Invalid permit
Work start-up & Obtaining  Personal injury involved in the work
5  Lack of
PTW  Property damage  All worker
competency
shall be
 Lack of / poor competent for
communication the job
 Establish proper
communication
channels
 Locate all
underground/above
ground facilities
referring to the
drawings
1. Leaking of 1- Gas coming into contact with Full of the PPE organize the PPI Acceptable
welding ignition source- Fire Explosion 2.Gas testing and professional l
gas severe injury burns, Injury. record 2Incorrectly technical
6 GAS TESTING 2. . Leaking 2-Back firing- Gas Cylinder getting stored gas training
of back fired possibility of cylinder cylinders being
Christmas getting fired or exploded knocked
tree over and damaged
3. Burning and the leaking gas
slag & sparks coming into contact
with an
ignition
source.
 2.Use protective
shelters to prevent
sparks
HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 4
 Additio
nal
hazard / Residual risk level
Step Description of job/task step Hazards and Inherent risk level (Acceptable /
Hazard/risk controls already in place risk Action by (Acceptable / not
No. (what and where) threats / causes not Acceptable)
controls Acceptable)
recomm
ended
1- Wear proper PPE.
2- Wearing masks over their
noses and mouths to
prevent them from
spreading the virus.
3- Conduct TBT before
work.
4- provide proper access.
5-All worker shall be
competent for job.
6-Establish proper
communication channels.
1-Unconscious 7-practicing social
2-Nausea distancing.
1- Lack of COVID-19 3- Fever 8- Screening the all visitors
precaution control 4- Sore throat and headaches. on construction sites.
procedure . 5-Fatigue. 9- Keep safe distance to
2- Lack of / poor 6- Racing heartbeat. other contractors and locals
7 COVID-19
communication 7- shortnees of breath. all time.
3- spread of this virus . 8-achy joints. 10- Practicing the COVID-
4-poor hygiene . 9- persistent loss of sense of 19 precaution and control
5-lack of awareness . smell. procedure.
10- damage to the heart ,lungs 11- Temperture daily
,kidney ,and brain . reporting system
implemented.
12- Always clean the hand
often.
13- Avoid touching your
eyes ,nose and mouth.
14- Limit gathering and time
spend in crowded places.
15-Avoiding physical
contact with other and
HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 maintaining a distance. Page 5
16-Clean and disinfect
frequently touched objects.
 Review – Performing Agency Approval – PetroChina Authorities

Area Authority Section Head / Deputy Manager

Discipline Engineer Contract Focal Department / PMC (If any) ☐ Approved - all non-routine jobs/tasks ☐ Approved – all routine jobs/tasks
☐ Confirmed - all routine jobs / tasks
Name Ali KAREEM Name Janardhan Name Name

Sign Sign Sign

Sign
 Hazard Prompt – “Check  ”
Identify the job/task hazards and assess the risks of personnel may be exposed to before safeguards are implemented
 Electrical ☐ Chemical ✓ Tools ☐ Gases
☐ Vehicles ☐ Height  Depth ☐ Weight
☐ Pressure ☐ Access ☐ Vibration ☐ Noise
☐ Weather /Working environment ☐ Bacteria  Dust  Slip / Trip
☐ Radiation ☐ Rotating Equipment ☐ Moving Equipment ☐ Lifting Equipment
☐ Heat ☐ Dehydration/ Hot Work /Sun ☐ Hot / Cold Objects ☐ Overhead Hazards
☐ Biological ☐ Entrapment ☐ Lighting  Manual Handling
☐ Conflicting Activities Others:
Personal Protective Equipment for Job/Task
Minimum PPE Requirements: 1) Goggles , 2 Helmet , 3) Safety shoes , 4) Gloves
☐ Safety Harness ☐ Face Shield ☐ Airline ☐ Gloves – Hyflex (Nitrile)
 Face Mask ☐ Sun Screen ☐ Dusk Mask ☐ Gloves – Leather Riggers
 Clear Safety Glasses ☐ Hearing Protection ☐ Confined Space Harness Others:
☐ Monogoggles ☐ Breathing Apparatus  Gloves - PVC
Plant, Equipment & Tools for Job/Task
☐ Ladder ☐ Drill ☐ Excavator ☐ MEWP (Mobile Elevating Work Platform)
 Hand Tools ☐ Grinder ☐ Winch ☐ Fans
☐ Shovel ☐ Scaffold ☐ Extension Leads ☐ Vacuum Cleaner
☐ Welding Machine  Fire Extinguisher ☐ Power Source ☐ Spill kits / Housekeeping
☐ Compactor ☐ Fire Blanket ☐ Crane Others:
Tagging & Signs
☐ Men Working Above ☐ Flagging ☐ Personal Danger Tags ☐ Information Tags
☐ Barrier Mesh ☐ Personal Locks ☐ Out of Service Tags Others:
Instructions, Permits, Certificates
 Method Statement  P & IDs  Cold Work Permit ☐ Isolation Certificate (Electrical) ☐ Radiography Certificate
☐ Procedures ☐ MSDSs ☐ Hot Work Permit ☐ Confined Space Certificate ☐ Demolition of Security Defense
☐ Work Instructions ☐ SIMOPS ☐ Gas test Certificate ☐ Road Closure Certificate
 Isolation Certificate
☐ Emergency procedure ✓ Toolbox talk  Excavation Certificate
(Physical)
 Hierarchy of Controls / Additional Notes

Hierarchy of Controls
Examples
Controls
Manual Handling Electrical

Elimination / Substitution of Hazard or hazardous
process
Isolation / separation of hazards from receptors
Engineering controls / safeguards for prevention
and mitigation
Use of other source of energy in place of electrical / use
Use of mechanical device instead of manual
of low voltage equipment
handling / Reduction in size or weight of the item
Use of specific rated enclosures, identify specific
Reduce the distance & time of exposure to
location
manual handling
Work place design, guarding / securing, local
exhaust ventilation, lighting etc., Use of correct fuses, grounding, proper spacing

Administrative & Procedural Controls Shift / rotation job, fitness, Method statement, Access control, Barriers, Signage, SOPs, Training,
Training, Permit to Work Competency, Permit to Work
Personal Protective Equipment Helmet, Electrical Shoe, Face shield, Apron, electrical
Helmet, Shoes, goggles, protective clothing etc., gloves etc.,

Notes:
Location / Agency / Discipline /Serial Number All non-routine jobs / contractors – Valid for specific task
JHA No# (CPF1 / PCH / Mech / XXX) Validity of JHA All routine jobs – Maximum validity should be 1 year or review on any
(CPF1 / CPECC / Mech / XXX) near miss / Incident occurrence.
Jobs/tasks those were identified as repeated nature to execute in
Non-routine jobs/ Jobs that requires a work permit as defined in the
Routine jobs/tasks operational areas on specific equipment by specific discipline without
tasks Procedure on Permit to Work System
change in the nature of working environment.
WO – Work Order number
Reference:
Location Eg., CPF1, Export pump area
(WO /Project #) PM – Preventive Maintenance number (from SAP)
Project – Project ID number
Team Leader should provide the brief description of the job / task being
Details of performing agency planned to carryout
Performing Job/Task
Eg., PCH- Mechanical or CPECC-Mechanical
Agency Description:
No different jobs / tasks should be clubbed even the execution team
might be same
 Team leader will select the team members based on disciplines involving
Job supervisor responsible for the defined job/task in the task execution, area concerned, competency, skills with the
Team Leader Team Members
execution consultation of Area Authority. Team should be limited to maximum of 6
members.
Job / task should be breakdown into basic steps based on
Description of Hazard and
task execution methodology & associated priorities & risks. Refer to Hazard prompt table (pg.3 of this JHA template)
job/task step Threat/Cause
(Maximum of 10 steps)
Potential Define the maximum potential loss /affect to the Health &
consequences on safety of the personnel involved, surroundings people, Hazard / risk
List out the existing controls that can limit the occurrence of loss /
Health, Safety, environmental emissions, damage to the assets etc., from controls already in
damage.
Environment and the identified hazard. It should consider no controls are in place
Asset place.
Acceptability of risk level will be subjected to the JHA team’
discretion based on the assessment of competency & skill
levels of the task execution personnel.
Inherent risk
JHA team may also consider the guidance from Risk Additional hazard / JHA team should identify the independent control measures as many as
levels
Assessment Matrix (consult with PCH HSE Manager) on risk controls possible even by incremental cost / investment for organizing necessary
(Acceptable / Not
identification of acceptable risk levels. recommended resources like people, equipment, time etc., to achieve the risk levels till
acceptable
acceptable levels.
For simplicity, all ‘Low’ category risks can be considered as
'acceptable' and other categories can be considered as 'not
acceptable'.
Team should determine that all residual risk levels are in acceptable
Team should identify the responsible action party for Residual Risk levels when the identified controls were in place at the time of task
establishing the identified controls, and ensure the level execution.
Action by
adequacy and efficiency of the functioning of controls on (Acceptable / Not However, Area Authority decision will be the final for confirming that the
right time. acceptable residual risk levels are acceptable, and will ensure to perform the task
with all identified controls measures in place.
Upon completion of the JHA, concerned discipline engineer
should review and confirm that the identified controls
Area Authority shall be responsible to approve all non-routine jobs /tasks
measures will be adequate for safe execution of the task.
and contractors’ JHAs by confirming the adequacy of control measures.
Review Discipline engineer can also suggest additional controls if Approvals
(performing any required. (PetroChina Area Authority shall be responsible to verity & confirm the adequacy of
agency) authority) control measures for all routine jobs / tasks, and Section Head / Deputy
PetroChina Contract Holder Department / PMC should be
Manager in charge of that particular operational area shall be
responsible to review the contractors’ JHAs and confirm
responsible to approve all the routine jobs/tasks.
that the identified controls will be adequate to perform the
task by contract workers in a safe manner.
THIS DOCUMENT IS UNCONTROLLED IF PRINTED OUT
TBT Form
Location: HF-168 Date:2021-10-31

1-Follow PCH&PMC procedure

2-Serious injuries from ruptured cables

3-Serious injuries from pipe rupture or high-pressure water blast
4-Damage to equipment and pipeline

5-Excavation hazards

PTW Reviewed Yes JHA Reviewed Yes

Work Leader Name and signature: HSE Supervisor Ali Kareem

NO Name Job position Signature

1 Kazem Shahal excavator driver
2 Murtada Zyara worker

3 Haider Kamel Civil engineer

4 Mustafa Rahi worker

5
6
7
8
9
10
11