FACILITIES SERVICES GROUP

WORK PERMIT
Date: July 21, 2021
FOR : SECURITY IN CHARGE
Type of Work
CONTRACTOR :
SCOPE OF WORK : Data-Voice Works Event
DATA VOICE - ADDITIONAL LAN/DATA/VOICE CONNECTION X Repair and Maintenance
BUILDING : BPI SINDALAN Construction
BRANCH/Department : BPI SINDALAN Preventive Maintenance
PCC Code BR00882
MACARTHUR HIGHWAY, BARANGAY SINDALAN,
LOCATION : CITY OF SAN FERNANDO, PAMPANGA 2000 Other/s:___________
DATE : From: July 21, 2021
Makati
To: July 21, 2021
TIME : From: 4:00pm To:1:00am

NO LIST OF PERSONNEL/WORKERS TOOLS TO BE USED

1 Elmer Rivera Ladder
2 Anthony Magbujos Power Tools
3 Sammuel Diongson Hand Tools
4 John Merruel Navida I.R Tester
5 Renz Fernandez Multitester
6 Aldrich Tanteo Knockout puncher
7 Enrico Deguino Grinder
8 Allan Caranto Extension Cord
9 Airvin Mayonte Hacksaw Blade
10 Romeo Ugat Jr. Foldable Ladder
11 John Mer Cerezo Hand Drill
12 Ronel Lajota
13 William Casin
14 Henry Cristobal
15 Mark Jay Alvarado

Prepared by: Requested by: Endorsed by:

Allan Caranto/John Ali Batac Engr. Franco Targa

Signature over printed name Signature over printed name Signature over printed name
Contractor Building Management BPI Representative

Noted by:

Signature over printed name

FSG-Security and Safety Management Division

Remarks:
 FSG - SECURITY AND SAFETY MANAGEMENT DIVISION
JOB HAZARD ANALYSIS
Date: July 21, 2021
CONTRACTOR : First Multi-tech Industrial and Development Corp.
SCOPE OF WORK : Data-Voice works

PERSONAL PROTECTIVE
N STEP BY STEP TASK HAZARD CONTROL MEASURE
EQUIPMENT

1 Secure Work Permit(s) SAFETY HAZARDS ENGINEERING

Slip Fall from height
CONTROL Safety Shoes
Electrocution □Fire
Follow Standard Compliance □ Explosion □ Cuts □ Machine Guarding □ Hard Hat
2 Poor housekeeping □ Falling Object □ Exhaust fan Gloves
(Applicable Codes)
□ Machine related hazard □ Ventillation □ Eye Googles
Toolbox meeting/ □ Confined space (low oxygen)
3 □ Others □ Others Safety Mask
Safety Orientatoon Please Specify:________________ Please Specify:___________ □ Harness and Safety Belt
BIOLOGICAL HAZARDS Wearable flashlight
4 Prepare Tools,PPE,Materials □ fungi /molds □ bacteria/viruses ADMIN CONTROL □ Fire Suit
□ insect bites □ allergies Toolbox Meeting □ Chemical Suit
Lock Out-Tag Out/Isolation □ Others
Check machine and tools □ SCBA
5 Please Specify:________
(For Electrical Related Works) PHYSICAL HAZARDS Housekeeping (5s) □ Ear muffs
□ Radiation □ Noise Fire Extinguisher □ Lab gown
6 Installation/Repair Works Extreme Temperature (hot or cold) □ Fire watcher □ Others
□ Sunlight exposure
□ poor illumination
□ Caution Tape/Sign Please Specify: Face Mask
□ Safety signage
7 Layout Conduit,Cable Pulling/ Others
Restorations Please Specify: Dust______ □ Pushcart
ERGONOMIC HAZARDS □ Insect Repellant
□ Vibration □ Heavy lifting □ Others
8 Termination of Connections Poor posture Repetitive task
Awkward position Please Specify:__________
□ Frequent lifting
9 Site Audit and Monitoring □ Too much force needed
□ Others
Please Specify:________________
10 Testing & Commissioning CHEMICAL HAZARDS
□ Fumes □ Vapors
□ Gases □ Toxic emission
11 Housekeeping □ Flammable material
□ Corrosive chemical
□ Checmical spills
12 Demobilization □ Others

Prepared by: Requested by: Endorsed by:

Allan Caranto/John Ali S. Batac Engr. Franco Targa

Signature over printed name Signature over printed name Signature over printed name
Contracotr Building Management BPI Representative

Noted by:

Signature over printed name

Safety Officer