FOR INFORMATION

0 31.03.2020 T.H.JANG J.I.KIM D.W.KANG FOR INFORMATION

Rev Date Prepared Checked Approved Details of Revision
Owner

Owner’s Engineer

Contractor

DOOSAN HEAVY INDUSTRIES VIETNAM

Sub-Supplier

Project

NGHI SON 2 BOT THERMAL POWER PLANT PROJECT

Title

Permit to Work for Commissioning

Document No. Rev. Page-No.

NS2-DN05-P0ZEN-860002 0 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

RECORD OF REVISION
Rev. Date Page Affected Description of Revision

0 31.03.2020 First Issue

Rev.0 1 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

CONTENTS

1. PURPOSE .............................................................................................................................3
2. SCOPE ..................................................................................................................................3
3. DEFINITION .......................................................................................................................3
3.1. PTW CHIEF CONTROLLER (COMMISSIONING ENGINEER) ...............................3
3.2. EXPERT AUTHORIZED PERSON (PTW ADMINISTRATOR) .................................3
3.3. PTW REQUESTER .............................................................................................................3
3.4. PERMIT TO WORK (PTW) ..............................................................................................3
3.5. ISOLATION & DE-ISOLATION CERTIFICATE (I.D.C.) ...........................................3
3.6. LOCK OUT / TAG OUT.....................................................................................................4
3.7. AREA PARTITION.............................................................................................................4
3.8. TAGS.....................................................................................................................................4
3.9. WARNING DISPLAY .........................................................................................................4
3.10. LOG BOOK FOR PTW DOCUMENTS ...........................................................................4
4. ORGANIZATION ...............................................................................................................5
5. RESPONSIBILITY..............................................................................................................6
5.1. OVERALL COMMISSIONING MANAGER ..................................................................6
5.2. COMMISSIONING ENGINEER.......................................................................................6
5.3. PTW ADMINISTRATOR...................................................................................................6
5.4. PTW REQUESTER .............................................................................................................7
6. PTW PROCEDURE ............................................................................................................8
7. LOCK OUT / TAG OUT.....................................................................................................9
8. PERMIT TO WORK FLOW CHART ............................................................................10
9. ATTACHMENT ................................................................................................................13

Rev.0 2 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

1. PURPOSE

The purpose of this procedure is to provide structure and process on the Permit to Work (PTW) System
and to ensure the proper flow of the permitting for the work requested under commissioning phase and
ensure that all persons performing work requiring the control of energy sources, during any phase of
site project during commissioning or testing are fully protected from unexpected injury to those persons
and/or equipment.
PTW shall be used to ensure that the equipment is isolated from all potentially hazardous and is
prohibiting unauthorized operation or inadvertent activation. Inadvertent activation includes unexpected
electricity energize contacting to compressed gases, pressurized or high temperature fluids, toxic
material, noisy environment, or elevated parts.

2. SCOPE

This procedure is applicable to all work being undertaken at the site, and shall apply to area, plants,
System/Sub-system, and apparatus which have been handed over from Erection/Construction parties to
Each Commissioning party after releasing the Mechanical Completion Certificate (MCC) for the
System/Sub-system.

3. DEFINITION

3.1. PTW Chief Controller (Commissioning Engineer)

shall mean the authorized Person who has been appointed to the general management for the PTW
work.

3.2. Expert Authorized Person (PTW Administrator)

shall mean the Lead Engineers from commissioning section of division who will contribute in
preparation of PTW and Equipment Isolation Instruction (E.I.I.) document.

3.3. PTW Requester

shall mean the authorized personnel able to request the PTW, such as the manager, deputy manager,
chief engineer and safety manager of Company or its subcontractor, and other Authorized Employees
(AE).

3.4. Permit to Work (PTW)

PTW shall mean the certificate, issued by the PTW Chief Controller, to provide safe environment to all
people working within the controlled areas.

3.5. Isolation & De-Isolation Certificate (I.D.C.)

Rev.0 3 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

Documents indicating the point of isolation in order to establish and maintain proper and safe isolation.

3.6. Lock Out / Tag Out

All specific area / equipments should be locked off and tagged out as per I.D.C. to ensure safe working
for the staff of Applicant Division. The Lock out Keys shall be kept in Key safe kept in the control of
PTW Chief Controller or assigned personnel by PTW Chief Controller.
LOTO Keys should always be kept in the LOTO box assigned to the specific LOTO for the work, under
control of the LOTO supervisor so there is no chance of unintentionally unlock potential hazards until
all work is complete and signed off

3.7. Area Partition

Fencing shall be required around energized area / equipment, if it is not available, Red & White colored
barrier tape with a warning display will be used for the area partition.

3.8. Tags
- Danger Tag:
A red tag attached to a switch or the isolation equipment to indicate/notify all persons that operation of
the subject item is prohibited.

3.9. Warning Display

A warning display related to a work permission document for the specific area and/or any other
warning display for a danger/restriction for the specific area.

3.10. Log Book for PTW documents

Records the issue and return for PTW. This Log Book shall be kept by PTW Chief Controller or
assigned personnel by PTW Chief Controller.

Rev.0 4 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

4. ORGANIZATION

①~⑥ : Flow of PTW Process

Overall Commissioning Manager

4 3* * This process to be applied to

overall commissioning stage and
when necessary.

PTW Chief Controller

(Commissioning Engineer or CCR Manager)

5 2

PTW Administator
(PTW Manager and Officers)

6 1

PTW Requester
All parties including their Sub - Contractor who will be
working in the Controlled area

Rev.0 5 of 13
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NS2-DN05-P0ZEN-860002

5. RESPONSIBILITY

5.1. Overall Commissioning Manager

shall give final judgment whether PTW is approved or not in the period of Commissioning, upon
reporting from Commissioning Engineer when judged necessary by PTW Chief Controller.
After Hot Commissioning is started, and CCR operation manager and Shift operation Leader are
assigned, CCR operation manager can judge/sign whether PTW is approved or not, on behalf of Overall
Commissioning Manager.

5.2. Commissioning Engineer

Commissioning Engineer has the right to issue the Permit to Work (PTW) to the Applicant Company or
its Division through PTW Administrator.
Commissioning Engineer or person directly assigned by Commissioning Engineer shall act as below;

[Evaluation & Reporting]

1) He shall control all documentation work required for PTW.
2) He shall be explained proposed written PTW from PTW Requester.
3) He shall review and evaluate requested PTW, and advice necessary update/correction when
necessary.
4) He shall report PTW to Overall Commissioning Manager for final judgment during in the period of
Plant Overall Commissioning, and when necessary.

[Confirmation before/after execution of PTW]

1) He shall assign personnel for control proper isolation or checking guarding of area to be prepared by
the PTW Requester in advance of execution of PTW. (when necessary or when required by the
PTW Requester)
2) He shall assign personnel for management the key safe for the control of Equipment Isolation keys
including the Log Book.
3) LOTO procedure all LOTO should be kept in the LOTO Box controlled by the LOTO Manager
4) He must be reported and be acknowledged completion of PTW and de-isolation under PTW in
written, details of any restrictions on returning the Plant and/or Apparatus to service.
After Hot Commissioning is started, and CCR operation manager and Shift operation Leader are
assigned, CCR shift leader/PTW manager can act as PTW chief controller to judge/take necessary
actions, such as isolation, etc. for each PTW, under coordination with Owner’s operation leader.

5.3. PTW Administrator

PTW Administrator shall be main window for receiving request of PTW from PTW Requester, and key
personnel for coordinating among parties including Owner’s operation team.

Rev.0 6 of 13
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NS2-DN05-P0ZEN-860002

After PTW Administrator receive PTW request from each PTW requester, he shall contact with each
related Commissioning Engineer and coordinate to receive approval from each related Commissioning
Engineer.
1) He shall contribute in preparation of PTW and Isolation & De-Isolation Certificate (I.D.C.)
document based on supportive drawings for PTW submitted by PTW Requester.
2) He will make sure that the isolations have been carried out in safe and proper manner.
3) He can assign the Engineers from commissioning section in order to carry out the specific activities
indicated on the I.D.C. Shift Operators are also part of this team.
4) He shall be responsible for distribution agreed PTW to related commissioning/operation parties
- Commissioning Engineer
- Shift Leader of Owner’s operator
- Leader of commissioning assistant
** PTW shall be mainly distributed by the PTW Requester, who has issued request of PTW.
- Site Manager
- Health and safety manager
- Security
- Concerned erection parties.

5.4. PTW Requester

1) He shall be authorized personnel able to request the PTW in the particular area. He is capable well
organize member of Erection Party.
2) He must know the area, system, nature, and type of activities which are indicated in the permit. He
shall provide a detailed PTW Application to PTW Administrator in writing and attach supportive
drawings (P&ID, General Arrangement Diagram, Single line Diagram, etc or Special work permit
such as Hot work, Confined Space work and Radiography approved by Erection Parties Authority)
to identify work area, system and limitation/isolation points. He must provide an accurate
explanation of work and risk involved with the work and safety pre-cautions to eliminate that risk.
3) Before commencement of PTW, implement the necessary measures to establish General Safety at
and in the vicinity of the workplace and instruct member in charge of Working Parties under PTW
in respect of General Safety provisions which must be maintained throughout the work.
4) He must control all work under the PTW.
5) He must report completion of PTW under PTW in written, details of any restrictions on returning
the Plant and/or Apparatus to service.
6) He shall report any modification or change of PTW.
7) He shall distributed approved PTW to the concerned parties;
- Site Manager
- Health and safety manager
- Security
- Concerned erection parties.

Rev.0 7 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

6. PTW PROCEDURE

This request for PTW must include a written Request to Work detailing the nature of the work to be
done and supportive drawings and documents that shows where this work will be conducted. This
request must be authorized by PTW Requester. The request must be approved by Individual
Commissioning Manager and/or Overall Commissioning Manager.
In order to ensure proper control of the PTW procedures, PTW Flow Chart on Section 8 clearly shows
the process flow and the respective responsibilities
After CCR operation manager and Shift operation Leader are assigned PTW request can be approved
by CCR operation manager and Shift operation Leader / PTW manager.

Rev.0 8 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

7. LOCK OUT / TAG OUT

Lock Out / Tag Out shall be secure before execution of PTW work, based on I.D.C. and remove after
completion of PTW work.
For the detail, please refer to “Lockout/Tagout (LOTO) Program”.

Rev.0 9 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

8. PERMIT TO WORK FLOW CHART

PTW Requester, planning to work

Work Planning & Prepare PTW
by PTW Requester
within the controlled area is required
to prepare 2 set of application sheets
of PTW.

N : Work is not acceptable
PTW administrator and Chief
Controller review if the Work is
acceptable
.
Chief Controller reviews the
submitted PTW and makes a first
judgement considering the plant
commissioning status, schedule,
influence to other work and so on.

Y : Work is acceptable

PTW administrator and Chief

N : Not necessary PTW administrator and Chief Controller checks if the applied work
Controller checks if equipment needs the isolation of equipment
isolation is necessary and/or area.

Y : Necessary

PTW administrator prepares I.D.C.

Prepare I.D.C. for Equipment based on supportive drawing for
/ Area by Expert Authorized PTW submitted by PTW Requester.
Person

In case that scope and/or area of

Equipment isolation shall be
N
executed jointly with Q.P. /
Supervisor of Applicant (Division)
isolation have to be confirmed by
Applicant (Division) at the work site,
the Applicant’s Qualified Person /
Supervisor shall join the isolation
work.

In case that joint isolation work is

not necessary, Comm. staff will carry
out the isolation work.
Y

Execute the equipment Where ever possible all the isolated

isolation by Comm. Section devices shall be locked and tagged.
Key for isolation shall be controlled
by individual PTW team.

After isolation work has been

completed signed PTW will be issued
Issue the PTW to Q.P. / to Qualified Person / Supervisor of
Supervisor of Applicant
Applicant (Division) by PTW Chief
(Division)
Controller or assigned personnel
through PTW administrator
By PTW Chief Controller or
assigned personnel
(8:30 on Monday to Saturday)

1 2

Rev.0 10 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

1 2
Isolation work and warning display shall be
executed jointly by PTW team and Qualified
Person / Supervisor of Applicant (Division)

Execute the
isolation and warning Where ever possible all the isolated devices shall
or area partition be locked and tagged. Key for isolation shall be
between PTW team Q.P. / controlled by individual PTW team.
Supervisor Applicant
(Division)

After isolation work has been completed and

Issue the PTW to Q.P. / confirmed by Qualified Person / Supervisor of
Supervisor of Applicant (Division), signed PTW will be issued to
(Division) by PTW
Controller or
Qualified Person / Supervisor of Applicant (Division)
by PTW Chief Controller or assigned personnel.

CCR and Electrical room access door key will be

Area Key for CCR and always in the possession of plant security. While
room will be controlled by working in controlled area under PTW, it will be
security. The Q.P. /
responsibility of Supervisor to restrict the entry of
shall request to plant security t
open/close the area access any unauthorized person in that area.
by approved .

The Qualified Person / Supervisor of Applicant

Area confirmation shall done (Division) shall confirm that the subjected
by Q.P / Supervisor Applicant
area/equipment is safe for working as per I.D.C. (by
(Division) starting the
checking Voltage, temp, etc), before starting the
work.

The Entry log provided by plant security shall be

Complete Entry Log filled, before entering CCR and Electrical room.
personnel of
(Division) before enter to
and Electrical

Carry out the work for which the PTW has been
obtained. After completion of work the safety
Complete the permitted for checks shall be carried out by Qualified Person /
equipment / Supervisor of Applicant (Division).

Area confirmation shall done The Qualified Person / Supervisor of Applicant

by Q.P / Supervisor Applicant
(Division) shall confirm that the subjected area is
(Division) completing the
cleared of any debris, test tool, etc after completing
the work.

Complete Exit Log personnel Make sure that the personnel of Applicant (Division)
of (Division) to make who had entered the restricted area to carry out the
sure that t Equipment / Area is work has left the controlled area and the exit log is
cleared any working staff. duly filled. Qualified Person of Applicant Division
Return t PTW to PTW Chief shall return back the PTW and related documents
assigned to PTW Chief Controller or assigned personnel.

Rev.0 11 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

PTW Chief Controller shall check if

N Confirm with PTW Chief
Controller if restoration of
isolated equipment / area is
necessary
restoration of isolated equipment / area is
necessary or not. He shall also check if any
equipment which was under share
responsibility between 2 or more divisions
needs any specific attention or not.

Check if the restoration work of any isolated

Equipment isolation and warning
N
display or area partition restoration
shall be executed jointly with Q.P. /
Supervisor of Applicant (Division)
apparatus or apparatus under shared
responsibility shall be done jointly by
commissioning staff and Qualified Person /
Supervisor of Applicant (Division) or only by
commissioning staff.

Restoration of equipment
isolation and confirmation
shall be done by Comm.
Section
(Right)
Y
In case any equipment was isolated under
I.D.C. to carry out the permitted work, then the
same shall be restored jointly by
commissioning staff and Qualified Person /
Supervisor of Applicant (Division) and the
Restoration of equipment
isolation and confirmation I.D.C. shall be closed
shall be done by Comm. (Left)
Section together with Q.P. In case any equipment was isolated to carry
/ Supervisor of Applicant out the permitted work, and restoration work
(Division) do not need presence of Applicant division,
then the same shall be restored by
commissioning staff and the I.D.C. shall be
closed.

PTW for Equipment / PTW shall be returned to the PTW Chief

Area return to PTW Chief Controller or assigned personnel after
Controller or Expert restoring the Isolations as per I.D.C.
Authorized person(s)

Close the PTW PTW Chief Controller shall check area /

equipment for safety before cancelling the
PTW.

Remove the Tag by PTW

Team. All the tags shall be removed by PTW Team.

Work completed

Rev.0 12 of 13
 Permit to Work for Commissioning
NS2-DN05-P0ZEN-860002

9. ATTACHMENT
Attachment 1. COMMISSIONING PTW FORM
Attachment 2. LOCK OUT TAG OUT PERMIT FORM
Attachment 3. ISOLATION & DE-ISOLATION CERTIFICATE FORM

Rev.0 13 of 13
 NGHI SON 2 PROJECT HEALTH & SAFETY MANUAL

Attachment.1- COMMISSIONING PERMIT

Emergency Number: 02373-862-595/097-9115-837

COMMISSIONING PERMIT/ GIẤY PHÉ P VẬN HÀ NH CHẠY THỬ Rev:05

PTW No./số
Company/subcontractor: Old PTW No./số cũ
Công ty/nhà thầu phụ Attached Document No.
Tài liệu đính kèm số:
Exact Working Location/ Vị trí làm việc chính xác:
Description of working activities/ Công việc cụ thể:

DETAILS OF THE PERMIT RECIVER (SC = Sub Contractor, DVN =Doosan Heavy Industry Vietnam)
Section/Phần – I
THÔNG TIN NGƯỜI NHẬN GIẤY PHÉ P(SC=nhà thầu phụ, DVN= Doosan Vina)
Name of Person In Charge Contact Number Signature
Họ Tên người phụ trách Số điện thoại Chữ ký
Permit Receiver/Engineer on site (SC)
Người nhận giấy phép (thầu phụ)
EHS Supervisor on Site (SC)/Giám sát
EHS trên công trường(thầu phụ)
Engineer Responsible on site
(DVN)/Kỹ sư phụ trách DVN trên hiện
trường

Section/phần – II PERMIT VALIDATIONS/ THỜI HẠN GIẤY PHÉ P

PERMIT ISSUE DETAILS/thời gian Time

Date/Ngày ________________
ban hành giấy phép /Thờigian____________ Valid for 1 day only
PERMIT EXPIRY DETAILS/thời gian Time Có hiệu lực chỉ trong 1 ngày
hết hạn giấy phép Date/Ngày ________________ /Thờigian____________
Attached
documents:
Tài liệu đính kèm 1. Method Statement(MS)/ biện pháp thi công
2. Job Safety Analysis (Copy for Site)/ đánh giá rủi ro công việc(bản copy)
3. Plot Plan/Workplace Drawing(Copy for Site)/bản vẽ (bản copy)

LOTO (Lock out Tag out)Khóa thẻ  Non - LOTO (Lock out Tag out)Không khóa thẻ 
Section/phần – IV: Hazard Control Implemented (Comments by Commissioning Dept.)
Các biện pháp kiểm soát mối nguy (do bộ phận chạy thử đánh giá)
Comments/ đánh giá

Section/ Phần – IV: Requried PPE and Safety Device (Checked by Commissioning Dept.)/ các phương tiện bảo hộ cá nhân và phương tiện an toàn

Hearing Protection  Face Shield  Fall protection  Respiration(Type) 

Bảo vệ tai Mặt nạ Chống rơi ngã Loại mặt nạ phòng độc
Flash suit  Gas Tester  Non entry rescure  Gloves(Type) 
Quần áo bảo hộ Máy kiểm tra khí Cứu hộ Loại găng tay
Other/khác: Adequate PPE as per JSA & MS requirement, other than mandatory PPE
Đầy đủ PPE theo yêu cầu JSA & MS , ngoài PPE bắt buộc
Declaration by the Permit Receiver/Engineer(SC)/ )/ Cam kết của Người Nhận Giấy Phép(kỹ sư-Nhà Thầu Phụ)

I acknowledged that all preparation work and safety requirements are in place, and that it is safe to proceed with the work.
Tôi khẳng định rằng đã chuẩn bị đầy đủ các yêu cầu về an toàn và đủ an toàn để thực hiện công việc.
Date/Ngày: ……/……/………… Name/Tên; ……………………………… Signature/Chữ ký………………

NS2-VA08-P0ZEN-169050 Rev.5 Page 34 of 49

 NGHI SON 2 PROJECT HEALTH & SAFETY MANUAL

Declaration by DVN Engineer on site/ cam kết của kỹ sư DVN tại công trường:

I acknowledged and fully understand the condition and precautions required. I will ensure that all personnel under my authority understand these requirements.
Tôi khẳng định đã biết tất cả các điều kiện và các biện pháp phòng ngừa. Tôi đảm bảo tất cả những người làm việc dưới quyền tôi cũng hiểu hết các yêu cầu
trên.
Date/Ngày: ……/……/…………. Name/tên: ……………………….. Signature/Chữ ký……………………

Section/ Phần - V: PERMIT APPROVAL/ CHẤP THUẬN GIẤY PHÉ P

Name of EHS Person In Charge/ Người chịu trách nhiệm an toàn DVN: …………………………………. Signature/ Chữ ký …………………..
Date/ Ngày …….../…..…./……………………
Comments/ Nhận xét

Name of the Doosan Area Manager/Giám đốc khu vực DVN: ………………………………..………… Signature /Chữ ký……………………………
Date/Ngày …….../…..…./……..

Comments/ Nhận xét:

Section -VI: WORK COMPLETION / CANCELLATION/ HOÀ N THÀ NH CÔ NG VIỆC/ HỦY

Isolation certificate No./chứng nhận số:

Name/tên: Sign/chữ ký: Date/Ngày:

Work Permit Holder/ người giữ
giấy phép

Name/tên: Sign/chữ ký: Date/Ngày:

System readied for normal service
(Construction Dept./CRE)hệ thống
đã sẵn sang cho hoạt động (Phòng
xây dung/CRE)

Name/tên: Sign/chữ ký: Date/Ngày:

All signature verified / Database
updated/Xác nhận toàn bộ chữ ký/
đã cập nhật cơ sở dữ liệu
Work permit controller/ người
quản lí giấy phép

Top Copy/ Work Site / PTW Box Middle Copy/DVN Engineer on site Bottom Copy/DVN EHS office
Bản gốc để trong hộp PTW tại nơi làm việc Bản copy 1/ kỹ sư DVN ngoài công trường Bản copy 2/ an toàn DVN (bản scan đóng PTW)

NS2-VA08-P0ZEN-169050 Rev.5 Page 35 of 49

 Attachment.2 -LOG OUT –TAG OUT Permit

Emergency Number/ Số điện thoại gọi khẩn cấp: 02373-862-595

LOCK OUT AND TAG OUT PERMIT
GIẤY PHÉ P LÀ M VIỆC CHO CÔ NG VIỆC KHÓ A VÀ DÁ N NHÃ N
Rev:01
PTW No./ Số
Company/subcontractor: Old PTW No./Số cũ
Tên công ty/ nhà thầu phụ Attached Document No.
Số tài liệu đính kèm:
Exact Working Location:
Vị trílàm việc chính xác:
Description of working activities:
Công việc cụ thể:

DETAILS OF THE PERMIT RECEIVER (SC = Sub Contractor, DVN =Doosan Heavy Industry
Section/Phần – I
Vietnam)/ THÔNG TIN NGƯỜI NHẬN GIẤY PHÉ P(SC=nhà thầu phụ, DVN= Doosan Vina)
Name of Person In Charge Contact Number
Signature/chữ ký
Họ Tên người phụ trách Số điện thoại
Permit Receiver/Engineer on site (SC)
Người nhận giấy phép(thầu phụ)
EHS Supervisor on Site (SC)/
Giám sát EHS tại công trường(thầu phụ)
Engineer Responsible on site (DVN)/
Kỹ sư phụ trách DVN tại hiện trường

Section – II/Phần 2 PERMIT VALIDATIONS/Thời hạn giấy phép

Time
PERMIT ISSUE DETAILS
Date/Ngày ________________ /Thờigian__________ NO EXTENSION WILL BE GIVEN ON THIS PERMIT
Thời gian ban hành giấy phép
__ (Not more than a week)
Giấy phép này không được gia hạn ( Chỉ được làm 1
Time / tuần)
PERMIT EXPIRY DETAILS/ Thời
Thời gian hết hạn giấy phép Date/Ngày_______________ gian:____________
Attached documents:
Tài kiệu đính kèm 1) Work Method Statement(MS)/ Biện pháp thi công
2) Job Safety Analysis (Copy for Site)/ Bản đánh giá rủi ro công việc (bản copy)
3) Workplace Drawing and photo(Copy for Site)/ Ảnh và bản vẽ khu vực thi công(bản copy)
4) Isolation – De-Isolation Plan/ Kế hoạch Ngắt và Đóng mạch điện

Section/ – III/ Phần 3 DAILY PERMIT REVALIDATIONS/ ĐÁNH GIÁ CÔNG VIỆC HÀ NG NGÀ Y
I have visited the work site area / location and understand the work activity, and will comply with the requirements of this Permit.
Tôi có đi kiểm tra khu vực thi công và thấy rõ công việc đang thi công và sẽ tuân thủ các yêu cầu trong giấy phép
Daily revalidation Date/Ngày 1 Date/Ngày 2 Date/Ngày 3 Date/Ngày 4 Date/Ngày 5 Date/Ngày 6 Date/Ngày 7
Đánh giá hàng ngày
Permit receiver(SC)
Người nhận giấy phép
DVN Engineer
Kỹ sư hiện trường DVN
Section – IV/ Phần 4: PREREQUISITE (Work shall be carried out ONLY after complying with the precautions given in Section IV of this Permit.)
Các yêu cầu thiết yếu (Công việc chỉ được tiến hành chỉ khi tuân thủ các yêu cầu ở phần IV)

 for YES and X for No Yes/  for YES and X for No Yes/
N/ A N/ A
 là CÓ and X là KHÔ NG No  là CÓ and X là KHÔ NG No
All switch boxes double locked up & verified?
Conduct S.T.A.R.T.
A K Các hộp chuyển đổi điện đã có 2 khóa và xác
Tiến hành họp S.T.A.R.T
nhận chưa?
Approved Work Method Statements provided? Affected employee notified?
B L
Đã trình biện pháp làm việc được phê duyệt? Những người bị ảnh hưởng đã thông báo chưa?
Adequate PPE as per JSA , other than mandatory Work area shall be Barricaded & Signage
C M
PPE/Đầy đủ PPE theo JSA, ,ngoài PPE bắt buộc Khu vực làm việc phải có rào chắn & biến báo

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 Attachment.2 -LOG OUT –TAG OUT Permit
Isolation plan provided? Earthing provided?
E O
Đã cung cấp kế hoạch ngắt mạch chưa? Tiếp địa đã được lắp đặt chưa?
LOTO is provided? Preparedness for emergency response?
F P
Đã khóa và dán nhãn chưa? Đã chuẩn bị cho ứng phó tình huống khẩn cấp?
Authorized person to remove LOTO identified? Other necessary precautions?
G
Người được ủy quyền tháo khóa được nhận diện? Các yêu cầu cần thiết khác?
1 5
Details of Employee working in 2 6
area/ thông tin người làm việc
Name, Company/ tên, công ty 3 7
4 8
Details of Equipment and/or
Material being used/ Thông tin
thiết bị vật tư cần dùng
Declaration by the Permit Receiver/Engineer(SC)/Cam kết của Người Nhận Giấy Phép(Nhà Thầu Phụ)

I acknowledged that all preparation work and safety requirements are in place, and that it is safe to proceed with the work.
Tôi khẳng định rằng đã chuẩn bị đầy đủ các yêu cầu về an toàn và đủ an toàn để thực hiện công việc.
Date/ngày: ……/……/………… Name/ Tên; ……………………………… Signature/ Chữ ký………………
Declaration by DVN Engineer on site/ Cam kết của kỹ sư DVN tại công trường:

I acknowledged and fully understand the condition and precautions required. I will ensure that all personnel under my authority understand these
requirements./Tôi khẳng định đã biết tất cả các điều kiện và các biện pháp phòng ngừa. Tôi đảm bảo tất cả những người làm việc dưới quyền tôi cũng hiểu
hết các yêu cầu trên.
Date/Ngày: ……/……/…………. Name/Tên; ……………………….. Signature/Chữ ký……………………

Section/Phần -V: PERMIT APPROVAL/ PERMIT APPROVAL/ CHẤP THUẬN GIẤY PHÉ P

Doosan EHS Person In Charge/ Người chịu trách nhiệm an toàn DVN: …………………………………. Signature/ Chữ ký ……………
Date/ Ngày …….../…..…./……………………
Comments/ Nhận xét

Name of the Doosan Area Manager/ Giám đốc khu vực DVN: ………………………………..………… Signature/ Chữ ký ………………………
Date/Ngày …….../…..…./……..

Comments/Nhận xét

Section/Phần -VI: WORK COMPLETION / CANCELLATION/ HOÀ N THÀ NH CÔ NG VIỆC/ HỦY

 The work is Completed, all personnel, tools and equipment have been withdrawn, area is left clean and tidy
Đã hoàn thiện công việc, toàn bộ người và thiết bị đã rút về, trả lại khu vực thi công sạch sẽ ngăn nắp
 The work "IS NOT" Completed, and will be continued on another Permit./ Công việc chưa hoàn thiện, tiếp tục mở giấy phép khác
 The work is "CANCELLED"/ Hủy công việc The work is "CANCELLED"/ Hủy công việc
Name/Tên: Signature/Chữ ký: Comment/ Đánh giá:
Permit Receiver/Người nhận giấy phép (SC)

Name/Tên: Signature/Chữ ký: Comment/ Đánh giá:

Permit Approver/ DVN EHS/ An toàn DVN
Người chấp
thuận giấy phép DVN Area Manager Name/Tên: Signature/Chữ ký: Comment/ Đánh giá:
Giám đốc khu vực DVN
Cancellation/ Hủy giấy phép: Name/Tên: Signature/Chữ ký: Reason/Lí do:

Top Copy/ Work Site / PTW Box Middle Copy/DVN Engineer on site Bottom Copy/DVN EHS office
Bản gốc để trong hộp PTW tại nơi làm việc Bản copy 1/ kỹ sư DVN ngoài công trường Bản copy 2/ an toàn DVN (bản scan đóng PTW)

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 Attachment 3

ISOLATION & DE-ISOLATION CERTIFICATE / CHỨNG CHỈ ĐÓNG & NGẮT MẠCH
AUTHORIZATION FOR ISOLATION / CẤP PHÉP CHO HOẠT ĐỘNG NGẮT MẠCH Attached to PTW No:

Isolation / De-Isolation points : To be completed by Authorized Electrical Person / Các điểm Ngắt/Đóng mạch: Được hoàn thiện bởi Người phụ trách về điện.

ISOLATION / NGẮT MẠCH DE-ISOLATION / ĐÓNG MẠCH

Isolation
ISOLATED by Witnessed by: DE-ISOLATED by: Witnessed by:
Isolation Requirement Isolation State
Tag No. Người ngắt mạch Được chứng kiến bởi Người đóng mạch Được chứng kiến bởi
Seq. Type (Electrical) (Mechanical) PADLOCK No.
Số nhãn Description / Chi tiết, Mô tả. DVN Authorized Person DVN Authorized Person
No. Kiểu ngắt Yêu cầu về Tình trạng (Máy Ống khóa Job Performer Name Job Performer Name
mạch ngắt mạch móc) Name Sign Sign Name Sign Sign
Tên Người tiến hành công Tên Người tiến hành công
(Điện) Tên Người được ủy quyền Chữ ký Chữ ký Tên Người được ủy quyền Chữ ký Chữ ký
việc việc
của DVN/ của DVN
1

ISOLATION TYPE / LOẠI HÌNH NGẮT MẠCH:_______________________ P: Process (Quy trình) M: Mechanical ( Máy mó c) E: Electrical (Điện ) C: Control (Điều khiển)

ISOLATION REQUIREMENT (PROCESS / MECHANICAL) ________________________ V : Valve (Closed / Open) B: Blank in placed / Removed S: Spade / Spectacle D: Disconnect (Disconnected / Reconnected) PB: Process Bleed
YÊU CẦU NGẮT MẠCH (QUY TRÌNH/MÁY MÓC) V: Van (Đóng / Mở) B: Trống / Tháo dỡ S: Xẻng / Kính mắt Ngắt kết nối ( Ngắt / Mở lại) Quá trình rò rỉ cột

I: Isolator Opened D: Disconnect (Disconnected CB: Circuit Breaker removed ( Removed /

ISOLATION REQUIREMENT (ELECTRICAL / CONTROL)_________________________ F: Fuse Removed (Removed / Replaced) E: Earthed (Applied / Removed) V: Valve (Open / Closed)
(Open/Closed) /Reconnected) Replaced)
YÊU CẦU NGẮT MẠCH (ĐIỆN/ĐIỀU KHIỂN) Tháo cầu chì (Tháo / Thay thế) Tiếp địa ( Đầy đủ / Tháo bỏ) Van (Mở / Đóng)
Bộ phận cách ly (Mở/Đóng) Ngắt kết nối ( Ngắt / Mở lại) Tháo cầu dao điện ( Tháo / Thay thế)

CONTINUE WITH SEPARATE SHEET IF SPACE PROVIDED IS NOT ENOUGH / TIẾP TỤC VỚI MỘT BẢNG RIÊNG BIỆT NẾU KHÔNG ĐỦ CHỖ TRỐNG Rev. 1