PERMIT TO WORK (PTW)

WP5100 – FIT – OUT WORKS AND SITEWIDE PRELIMINARIES

PERMIT TO WORK NO:
Work Title TESTING & COMMISSIONING OF MECHANICAL VENTILATION
Location NTB SUBSTATION - SOUTH PIER - BLDG. 3, ZONE 3 – TILE 4, APRON LEVEL

Issued To: MGCJV Company Phone: 09167658238

(C ONTRACTOR COMPANY)
(MANDATORY)

Supervisor’s Name: ARNEL LAYUG Mobile Phone: 09776035423

I understand the work that is to be carried out and the safety precautions that are necessary to complete the work safely. If conditions are such that the risk
assessments become invalid it is my responsibility to stop work immediately and notify the person who authorized this permit to work. The disposal of any
residues of the hazardous materials used will be in accordance with the CLIENT ENVIRONMENTAL POLICY AND TO THE EXISTING PHILIPPINE
ENVIRONMENTAL LAW IMPOSED BY THE DEPARTMENT OF ENVIRONMENTAL AND NATURAL RESOURCES (DENR).

No. of Workers: ___10___

Description of Work
TESTING & COMMISSIONING OF MECHANICAL VENTILATION SYSTEM

Type /Nature of work involved - tick where applicable (Separate form to be attached for Hot Works):

Work at height (>2m) Dust/Fumes Hot Works Noisy Works

Scaffolds/Elevated Painting works Confined Space Equipment

Civil/ Architectural Electrical Fire Pro Cold

Mechanical Plumbing Others
U

Tools and Equipment to be used

Worker’s Name:
Vane Anemometer
Digital Manometer 1. WILBERT H. BALINGIT
2. JEROME P. BERONIO,
Pitot Tube 3. AMIEL JAY C. MERCADO,
4. MARK M. CALLE,
5. ELEADOR SANTOS JR.
Clamp Meter
6. JOE MARK SANTOS
7. KRYSTOFFER MIGUEL
Hand Drill
MENDOZA
Measuring Tape 8. CHRISTIAN COLO
9. LARRY JUNIO
Scaffolding & Ladder 10. JEROME FRONDINA

Form No.: TPM_PF_PJW_0088

 ATTACHED JHA/METHODOLOGY, KEY PLAN YES

NO
System Isolations Required (Separate Forms to be attached)
Electrical Sprinklers Smoke Detectors HVAC Others: __________________________

ALTERATION & ADDITION ACCESS POINT: POINT 1 POINT 4

DEFECT/PUNCH LIST RECTIFICATION (Security to assign) POINT 2
POINT 5
OTHERS: _____________________ POINT 3

Inclusive Dates: Jan. 24, 2022 to Jan. 26, 2022 Time: 8:00 AM/PM to 5 :00 AM/PM
(CRK-PMT)
REPRESENTATIVE
(NAME AND SIGNATURE)

(NAME AND SIGNATURE/DEPARTMENT)

MY SIGNATURE SIGNIFY THAT THE APPOINTED CONTRACTOR ABOVE IS STILL UNDER MY ACCOUNTABILITY DURING
IMPLEMENTATION OF WORKS AND ENDS AFTER THE SIGNING OF CERTIFICATE OF COMPLETION. AS SUCH, OTHER TERMS AND
CONDITIONS OR ANY VIOLATION OF THE SAME WILL BE REFERRED TO THE PREVAILING SOLAIRE TEAM MEMBER CODE OF GOOD
BEHAVIOR FOR ANY CORRECTION TO BE MADE

RGSP ISSUER
SAFETY HEAD

SUBCONTRACTORS/TRADE CONTRACTORS
PTW RECEIVER

RULES FOR CONTRACTORS

Through co-operation and by following these basic rules you will help keep this site a healthy and safe workplace.
The following rules apply to you and anyone employed by you (including all sub-contractors) and it is your responsibility to ensure that they
are made aware of these requirements and comply with them at all times:

1. MOVEMENT ON SITE:
Vehicle and pedestrians movements on site must be in accordance with local traffic and restricted to those areas agreed with the "Company"
2. COMPETENT PERSONS:
Persons employed by you shall be competent to undertake the work specified and be able to operate any necessary equipment safely and
without risk.
3. RISK ASSESSMENTS:
Any of your activities which pose a significant risk to the health and safety of people, property, plant or product must be formally assessed, and
those most likely to be affected, informed of the risks and safety measures that are to be taken.
4. TOOLS AND EQUIPMENT:
Shall be of good working condition and fit for the intended purpose.
5. PORTABLE ELECTRICAL EQUIPMENT:
Shall possess a current test certificate. Voltage requirements should not exceed 240 volts unless protected by a suitable residual current circuit
breaker.
6. PERSONAL PROTECTIVE EQUIPMENT (PPE):
For certain tasks or in specified areas the wearing of suitable PPE shall be strictly enforced.
7. HYGIENE:
Applicable hygiene rules will be strictly enforced.
8. FIRE & SAFETY:
Notices are displayed throughout the premises, you must be aware of the procedures and what action to take if the fire alarm is sounded or if
you discover a fire.
9. ACCIDENTS:

Form No.: TPM_PF_PJW_0088

 In the event of an accident to yourself or to anyone under your control it must be reported to your site contact as soon as is practical to do so.
10. SMOKING:
A smoking policy is in place and observance of the policy rules must be strictly obeyed.
11. ALCOHOL and CONTROLLED SUBSTANCES:
THE CONSUMPTION OF ALCOHOL IN PREMISES IS STRICTLY PROHIBITED, MOREOVER ANYONE FOUND TO BE UNDER THE INFLUENCE OF ALCOHOL OR OTHER CONTROLLED
SUBSTANCE WILL BE REMOVED FROM THE PREMISES AND NOT PERMITTED TO RETURN
12. NOISY WORKS
All noisy works must be managed to avoid disturbance to the hotel and casino operations. Coordinate with the project owner to determine
the proper timing of such activities.
13. BOARD UP
Workplace in public areas shall be boarded up with sturdy and presentable materials to match the existing finish of the hotel & casino
14. DUST & FUMES
Adequate controls shall be applied to prevent smoke and fumes from spreading to the other parts of the property.
15. SYSTEM ISOLATIONS
System shutdowns shall be coordinated with the project owner for proper scheduling of activities. Fill up appropriate impairment forms for
fire life safety systems. Contractor must ensure that the isolated system is put back in operation and that the project owner is informed as
soon as the work is completed.
16. WORKPLACE
Workers are allowed access only to the areas specified in this permit. Key Plan must be attached with this permit. The contractor shall enforce
good housekeeping in the area. Avoid accumulation of rubbish and unnecessary materials.
17. WORKERS LIST
The contractor must attach its workers list with this permit. Any worker that is not included in the list shall not be allowed access in the
property.

What PPE (Personal Protective Equipment) is required to complete the work safely (please check):
Hard Hats
Hearing Protection
Safety Footwear
Fall Arrest / Restraints
Gloves or Other Hand Protection
Eye / Face Protection
High Visibility Clothing Barriers & Signs
Screens
Respiratory Protection
OTHER EQUIPMENT NOT LISTED ABOVE:

Contractor to issue to F&E. F&E to review/approve and forward to Security for final approval.

Form No.: TPM_PF_PJW_0088