REV 3_07-01-2022 WORK PERMIT

Single-Use Longterm Use

Control No.:
Cold Work Hot Work Confined Space Entry Excavation Critical Lifting Work
Location NPC GRF Date Issued 12/27/2022 Valid Until 1/2/2023 Work Request No.

Equipment I.D. N/A Time 0800H Time 1700H

Working Group: (Pls. Use back page for multiple contractor)
MPDSI/SPPC Group: In house Contractor: Other External Contractor:

TSD/Project Engineering N/A AG&P/SCIC

(Department/Section) (Company/Department/Section) (Company/Department/Section)
Description of Activities: (Pls. use back page for more details)
GENERAL COLD WORK ACTIVITIES:
1. Site clearing for proposed pipe route; 2. Minor scaffolding as needed (e.g. temporary bridge for piping); 3. Delivery of
piping materials and pre-cast concrete sleeper, etc.; 4. General surveying works; 5. Tree cutting; 6. Hauling of spoiled
materials. (e.g. soil, trees); 7. Minor painting activities (e.g. cosmetics, touch up); 8. Pipe lifting and dragging into position;

Important Instructions & Notes: (Pls. use back page for more details)
All activities should be per approved Method Statement (MS) and ITP, and Contractor shall have a hard copy available at
site. A Job Safety Analysis (JSA) shall be complied and readily available at site;

Process/ Equipment Preparation Special PPE and Protective Device Additonals Documents & Attachments
(Check if Required) (Check if Required) (Check if Required)
Equipment/Line Isolation Chemical Suit Hot Work Permit
Equipment/Line Draining Fire retardant suit Confined Space Entry
Gas Venting/Purge w/ inert gas SCBA/ Air Line Excavation Work
Water sealing/Floating Full/Half Mask Respirator Critical Lifting
water flushing/ Steaming out Safety Harness Job Safety Analysis
Chemical washing/ Neutralizing Fall protection safety net SDS for Chemicals
Lockout & Tagout at local Insulated Gloves & Boots Structural design
Tagout only at local Portable Gas Detectors Rigging/Laydown plan
Equipment on test mode H2S Monitor Alternate Route plan (Road Blockage)
Others: Others: Others:

WORK APPROVAL WORK ACCEPTANCE

1. Work Permit Requested By: 1. Work Done By:
(Indicate Date of request) MA Del Mundo (Indicate Date of work completion)
Name & Signature Name & Signature
2. Work Permit Endosed By: 2. Work Inspected by:
(MPDSI/SPPC Supv or Supt) MA Del Mundo (Aux Operator)

Name & Signature Name & Signature

3. Work Permit Checked By: 3. Equipment ready for Re-energizing
(MPDSI Safety officer) (For Equipment w/ Lockout/Tagout)
Note: can be waived if cold work only

Name & Signature Name & Signature

4. Work Permit Approved By: 4. Work Accepted by:
(Ops Shift Supv on duty) (Operations Shift Supervisor)

Name & Signature Name & Signature

5. Work Permit Attachment Verified By: 5. Work Verified by:
(Operations Shift Superintendent) (Operations shift superintendent)

Name & Signature Name & Signature

Permit Cancellation: (Reason for Permit cancellation) Permit Extension Requested By:

Name & Signature

New Permit validity:
Date:
Permit Cancelled By: (MPDSI/SPPC) Time:
Indicate Date
Extension Approved By:
(Ops Shift Superintendent)

Name & Signature Name & Signature

 HOT WORK PERMIT
REV 3_07-01-2022
Control No.:

Location NPC GRF Date Issued 44,922.00 Valid Until 44,928.00 Work Request No.
Equipment I.D. N/A Time 0800H Time 1700H -
Working Group: (Pls. Use back page for multiple contractor)
MPDSI/SPPC Group: In house Contractor: Other External Contractor:

TSD/Project Engineering N/A AG&P/SCIC

(Department/Section) (Company/Department/Section) (Company/Department/Section)

Description of Activities: (Pls. use back page for more details)

GENERAL COLD WORK ACTIVITIES:
1. Site clearing for proposed pipe route; 2. Minor scaffolding as needed (e.g. temporary bridge for piping); 3. Delivery of
piping materials
Important and pre-cast
Instructions & Notes: concrete sleeper, etc.; 4. General surveying works; 5. Tree cutting; 6. Hauling of spoiled
(Pls. use back page for more details)
All activities should be per approved Method Statement (MS) and ITP, and Contractor shall have a hard copy available
at site. A Job Safety Analysis (JSA) shall be complied and readily available at site;
Preparation Checklist
Process or Equipment Preparation Y N N/A Remarks
Equipment & lines depressurized,drained or vent-out
Equipment & lines Isolated and Blinded
Equipment & lines water flushed, steamed or Purge-out
Equipment & lines De-energized or Locked-out & tagged-out
Work group site preparation
Hotwork equipment tested, checked if good condition
Barricades, Tarps or Canvass installed to isolate hotwork area
Sewers, Holes & Combustible floors covered by blankets
Job site clear of trash, flammable & combustibles materials
Additional Fans/ Blowers to preven accumulation of combustible dust
Gas tanks/cylinders properly secured moved away
Other Work Preparation and Detailed Instruction:

Fire - Safety Protection Requirements & Special PPE

Fire - Safety Protection Requirements Y N N/A PPE Y N N/A
Fire Watch Hose Full sleeve Leather/ Fire retardant jacket
Fire Extinguisher at job site Welding gloves
Charged Fire Hose w/ Nozzle Face shield/ Welding mask
Fire retardant/ Asbestos Blankets Leather Apron
Gas Reading
Gas tested By:
Vessel or Line Internals : Indicate Date of testing
(If Possible/ accsible) O2% LEL

Name & Signature

Environment: O2% LEL
Other Safety Precautions:

Incase of fire report immedietly to the following emergency contact number.

Control Room Contact Number- Safety Office -
Security Office -

Work Permit Requested By: MPDSI Safety Personnel

(Indicate Company & Position) -
-
Name & Signature Name & Signature
Permit Cancellation: (Reason for Permit cancellation) Permit Extension Requested By:

Name & Signature

New Permit validity:
Date:
Permit Cancelled By: (MPDSI/SPPC) Time:
Indicate Date Extension Approved By:
(Ops Shift Superintendent)

Name & Signature Name & Signature

 CONFINED SPACE ENTRY PERMIT
REV 3_07-01-2022
Control No.:

Location NPC GRF Date Issued Work Request No.

12/27/2022 Valid Until 1/2/2023
Equipment I.D. N/A Time 0800H Time 1700H
Working Group: (Pls. Use back page for multiple contractor)
MPDSI/SPPC Group: In house Contractor: Other External Contractor:

TSD/Project Engineering N/A AG&P/SCIC

(Department/Section) (Company/Department/Section) (Company/Department/Section)

Description of Activities: (Pls. use back page for more details)

Excavation is at 4 meters deep and is considered a confined space.

Important Instructions & Notes: (Pls. use back page for more details)
Egress/ingress to the deep excavation should be per approved Method Statement. Monitoring of gas leak
from the 16" FG line shall be implemented regularly.

Atmosphere Monitoring
Gas Tested Safe level 1st Gas Reading 2nd Gas Reading 3rd Gas Reading Gas Tested By: Date & Time
O2 19.5 -21. % % % % 1st:

LEL 0 % % % % 2nd:

CO 500 ppm ppm ppm ppm 3rd:

H2S 0 ppm ppm ppm ppm Extension:

Other Toxic Gases:
Confined Space Requirements Remarks
Mode of Ventilation Natural Venticaltion Force Ventilation
Lighting System Natural Lighting Electric Lighting
Use of Breathing Apparatus Self-Contained Air Line supplied
Mode of Communication Signs or Signal Rope Radio/ Direct line
Rescue Procedure

Name of authorized entrants (Pls. use back page for more details)

1. 6.
2. 7. (Watcher's Name)
3. 8.
4. 9.
5. 10. (Team Leader's Name)

Other Safety Precautions:

Incase of emergency report immedietly to the following emergency contact number.

Control Room Contact Number- Loc. 243 Safety Office - Loc. 142
Security Office - Loc. 125

Work Permit Requested By: MPDSI Safety Personnel

(Indicate Date of Request) MA Del Mundo
Name & Signature Name & Signature
Permit Cancellation: (Reason for Permit cancellation) Permit Extension Requested By:

Name & Signature

New Permit validity:
Date:
Permit Cancelled By: (MPDSI/SPPC) Time:
Indicate Date Extension Approved By:
(Ops Shift Superintendent)

Name & Signature Name & Signature

 EXCAVATION PERMIT
REV 3_07-01-2022
Control No.: -

Location NPC GRF Date Issued 12/27/2022 Valid Until 1/2/2023 Work Request No.
Equipment I.D. N/A Time 0800H Time 1700H -
Working Group: (Pls. Use back page for multiple contractor)
MPDSI/SPPC Group: In house Contractor: Other External Contractor:

TSD/Project Engineering N/A AG&P/SCIC

(Department/Section) (Company/Department/Section) (Company/Department/Section)

Description of Activities: (Pls. use back page for more details)

GENERAL COLD WORK ACTIVITIES:
1. Site clearing for proposed pipe route; 2. Minor scaffolding as needed (e.g. temporary bridge for piping); 3. Delivery of
piping materials and pre-cast concrete sleeper, etc.; 4. General surveying works; 5. Tree cutting; 6. Hauling of spoiled
Important Instructions & Notes: (Pls. use back page for more details)
Excavation shall be per approved Method Statement.

Work Area Preparation

Digging Site Inspection Y N N/A Digging Site Preparation Y N N/A
Digging Site drawing available ✔ Site perimeter secured by caution tape ✔
Utility pipes present on digging site? ✔ Only one access to digging site ✔
Power lines present on digging site? ✔ Access ladder properly secured ✔
Sewers/ water ways present on site? ✔ Shoring tools available? ✔
Source of toxic gas present? ✔ Additional Lights on the dig hole? ✔
Source of combustible gas present? ✔ Additional ventilation on the dig hole? ✔
Method of Excavation

Manual (Pick & Shovel) Electric driven eqp't Gas/Hydrualic driven eqp't Excavator/heavy machinery

Excavated Materials Dumping

For Backfilling to To be hauled outside To be hauled to other Other pls. specify:
same dug hole the plant premises area for backfilling
Other Safety Precautions:

Incase of fire report immedietly to the following emergency contact number.

Control Room Contact Number- Loc. 243 Safety Office - Loc. 142
Security Office - Loc. 125

Work Permit Requested By: MPDSI Safety Personnel

(Indicate Company & Position) -
MA Del Mundo
Name & Signature Name & Signature
MPDSI Project Engineering:
(TSD-Superintendent)
MA Del Mundo
Name & Signature
Permit Cancellation: (Reason for Permit cancellation) Permit Extension Requested By:

Name & Signature

New Permit validity:
Date:
Permit Cancelled By: (MPDSI/SPPC) Time:
Indicate Date Extension Approved By:
(Ops Shift Superintendent)

Name & Signature Name & Signature

 CRITICAL LIFTING PERMIT
REV 3_07-01-2022
Control No.: -

Location NPC GRF Date Issued 44,922.00 Valid Until 44,928.00 Work Request No.
Equipment I.D. N/A Time 0800H Time 1700H -
Working Group: (Pls. Use back page for multiple contractor)
MPDSI/SPPC Group: In house Contractor: Other External Contractor:

TSD/Project Engineering N/A AG&P/SCIC

(Department/Section) (Company/Department/Section) (Company/Department/Section)

Description of Activities: (Pls. use back page for more details)

GENERAL COLD WORK ACTIVITIES:
1. Site clearing for proposed pipe route; 2. Minor scaffolding as needed (e.g. temporary bridge for piping); 3.
Delivery
ImportantofInstructions
piping materials
& Notes: and(Pls.
pre-cast concrete sleeper, etc.; 4. General surveying works; 5. Tree cutting; 6.
use back page for more details)
All activities should be per approved Method Statement (MS) and ITP, and Contractor shall have a hard copy
available at site. A Job Safety Analysis (JSA) shall be complied and readily available at site;
Load Details Lifting Details Accessories
Load Gross Weight : lbs/Kgs Max Lifting Height: ft. Smallest Shackle in.
Load is symmetrical: Yes No Max Hang time/ Lift: min. Smallest Cable/Sling Size in.
Built-in lifting lugs: Yes No Distance travel of load: ft. Use of Lifting Frame Yes No
Lifting Equipment Details
Crane Set-up Checklist
Jib / Overhead Crane Mobile Crane/ Boom Truck
Install Out-Rigger pads
Overhead Crane No: Type of Boom: Side Lifting allowed
SWL: Rated Capcity: Traveling while on lifting allowed
No Bend/twisted on the Cable Hoist Type of Wheels: Use of Only support/aux hook
Hook's locking device fucntioning Company Owner: Lifting on N-Shift allowed
All bottons in the controller functioning Date of Third Party Inspection: Use of Extension Jib
No Unsual sound during testing Name of TPI & Certifying Body: Tandem/Simultaneous Lifting allowed
Key Personnels

(Name of Rigger) (Name of Crane Operator) (Name of Rigging Supervisor)

Incase of fire report immedietly to the following emergency contact number.
Control Room Contact Number- Safety Office -
Security Office -

Work Permit Requested By: MPDSI Safety Personnel

(Indicate Company & Position) -
-
Name & Signature Name & Signature
MPDSI Project Engineering: MPDSI Electrical Maintenance:
(TSD-Superintendent) (Electrical Maint. Supv) -
-
Name & Signature Name & Signature
Permit Cancellation: (Reason for Permit cancellation) Permit Extension Requested By:

Name & Signature

New Permit validity:
Date:
Permit Cancelled By: (MPDSI/SPPC) Time:
Indicate Date Extension Approved By:
(Ops Shift Superintendent)

Name & Signature Name & Signature

LOTO for Work Permit No.:
Description of Work :

Date :
Time :
Prepared by :
Concurred by :
SAFETY :
Authorized by :
Noted by :
Department :

INITIAL & SIGNATURE

EQUIPMENT
OPERATOR SUPERVISOR
REQUIRED
TAG NO. DESCRIPTION STATE LOCK DATE UNLOCK DATE IMPLEMENT RELEASE

Legend for Required State:

DE Denergized GR Grounded DR Drain

EN Energized DS Disconnected VN Vent
CL Closed BD Blinded PD Padlock
OP Open PR Purge
Approval/Issuance
Not Critical Work
Steps
(Cold Work, Inspection, Measurement, Testing etc)

1 Requestor will fill-up Normal work permit

2 Requestor will print via PDF the work permit
3
Requestor can waive signature of Safety Officer
4
Requestor will go to the control room to seek approval of shift supervisor
Shift Supervisor and Shift superintendent shall accomplish the lock out
5
tagout form if needed

6 Shift Supervisor shall ask the Aux/field operator to execute the lockout tag-
out or isolation
7 Shift superintendent will issue the work permit to the requestor after
verification of the lockout or isolations

Requestor shall keep the Normal Work Permit for the entire work duration.
8
Request for Extension if necessary

Acceptance/ Completion
Not Critical Work
Steps
(Cold Work, Inspection, Measurement, Testing etc)

1 Requestor will sign the Normal work permit

Requestor will call the Field Operator to inspect the area and seek for
2
signature

3 Fiel Operator shall also check if the equipment is ready to re-energize or

Lock-out tagout can be removed
4 Requestor will go to the control room to seek approval of shift supervisor
Shift supervisor shall ask the Aux/field operator to remove the lockout tag-
5
out

6 Shift superintendent will verified the work and keep the original copy of
permit
7 Requestor shall photocopy the completed work permits and all of the
attachments.
8 Requestor shall keep separate files of the photocopys
 General Guidelines
Critical Works
(Hot Work, Confined Space entry, Excavation, Crit Lifting) 1 Only MPDSI/SPPC (Organic) Pe
Requestor will fill-up Normal work permit a. In house contractor and Ext
Requestor will fill-up Normal work permit and Specific work permit
Requestor will print the work permits
Requestor shall call the safety officer and both of them shall perform area
checking 2 Permit Duration/Validity
Requestor will go to the control room to seek approval of shift supervisor
and give the control number a. If Single Use only: Validity is
Shift Supervisor and Shift superintendent shall accomplish the lock out
tagout form b. If long term: validy is 7 days
Shift Supervisor shall ask the Aux/field operator to execute the lockout tag-
out
Shift superintendent will issue the work permit to the requestor after
verification of the lockout or isolations
Requestor shall keep the Normal Work Permit for the entire work duration.
Request for Extension if necessary
Requestor shall renew the Special Work Permit (HW, CSE, Exc, CL) for every
24 hrs or extend by 8 hrs only.

Critical Works
(Hot Work, Confined Space entry, Excavation, Crit Lifting)
Requestor will sign the Normal work permit
Requestor will attached the last Special permit applied to the NWPermit
Requestor will call the Field Operator to inspect the area and seek for
signature
Fiel Operator shall also check if the equipment is ready to re-energize or
Lock-out tagout can be removed
Requestor will go to the control room to seek approval of shift supervisor
Shift supervisor shall ask the Aux/field operator to remove the lockout tag-
out
Shift superintendent will verified the work and keep the original copy of
permit
Requestor shall photocopy the completed work permits and all of the
attachments.
Requestor shall keep separate files of the photocopies
 General Guidelines

nly MPDSI/SPPC (Organic) Personnel can apply for work permit

In house contractor and External contractor shall coordinate with their organic counterpart representative for their schedule so that

ermit Duration/Validity

If Single Use only: Validity is 24 Hours and Extension is 8 hours only

If long term: validy is 7 days max and Extension is 8 hours only.

Procedure For critical Lifting

1
for their schedule so that the organic personnel can prepare ahead the permit