WORK PERMIT FORM

Name of Company: Name of Contact Person & Number: Date Issued:

Metropolitan String Quartet SERJOE ORVEN GUTIERREZ
Work Location: Validity Period Estimated Duration Work Permit No:
From To
Date:

Time:
Brief Description of Work

OHS HAZARDS IDENTIFICATION, RISK ASSESSMENT & CONTROLS

(To be filled-up by the Project Owner together with Service Provider/ Contractor. Check all applicable items)

Tick applicable activities to be involved:

Work on electrically driven Hot Work: welding, cutting, brazing, Working on height (6 meters & Generation of hazardous materials/
equipment/ live circuit** etc.** above) waste
Confined space ** Excavation/ Demolition** Use of forklift, crane, genset, etc Lifting heavy materials,> 50kg
Heavy equipment maintenance: disassembly, overhaul, etc.** Others, specify:

Tick applicable environmental aspects/ OHS hazards:

ASPECTS/ HAZARDS CONTROL MEASURES
Bump/ slip/ fall/ trip Proper housekeeping; Danger signs and safety instruction; Use of appropriate PPE (safety shoes, hard hat);
Caught in/ between/ on mechanical parts Proper housekeeping; Use of appropriate PPE (safety shoes, hard hat), install guards to moving/ rotating parts; Danger
signs and safety instruction
Chemical/Fuel/ Oil leaks or spills Proper handling, storage and work procedure and supervision; Secondary containment/ catch pan; Danger signs and
safety instruction; Use of appropriate PPE (gloves, goggles, safety shoes); Emergency Preparedness and Response
Procedure in place
Compressed gas leaks Proper handling, storage and transport of compressed gases; Regular gas leak test
Contact with electrically energized lines/ objects Implement LOTO; Danger signs and safety instruction; Secure/ control electrical cords; Take caution when plugging and
unplugging electrical equipment and appliances; Metal ladders not to be used for electrical work or in areas where they
could contact energized wiring; Use of hand tools with insulated handles
Contact with hot surfaces/ objects Danger signs and safety instruction; Use of appropriate PPE (heat resistant gloves)
Contact with sharp/ pointed objects/ tools Proper housekeeping; Use of appropriate PPE (safety shoes, hard hat), install guards to moving/ rotating parts
Earthquake >5-Intensity Emergency Preparedness and Response Procedure
Emission from combustion engines Permit to Operate of equipment; Regular preventive maintenance operations; Use of appropriate PPE (mask);
Extreme weather conditions, i.e., strong rain/ Suspension of outdoor work where necessary
wind
Fall from height Use of appropriate step ladder or scaffoldings; Implement Ladder Safety; Danger signs and safety instruction; Use of
appropriate PPE (safety shoes, hard hat, safety belt & lifeline, fall arresters);
Falling objects Use of catch net where practicable; Proper housekeeping; Observe proper stacking of supplies & materials; Danger
signs and safety instruction; Use of appropriate PPE (hardhat and safety shoes)
Fire/ Explosion Danger signs and safety instruction; Provision of fire extinguishers on site. Observe "No Smoking" regulations and
electrical safety
Generation of contaminated wastewater Where applicable, direct flow to STP/ oil separator; Collect contaminated wastewater
Generation of solid wastes Observe waste segregation; Observe proper handling, storage and disposal of wastes
Ionizing radiation Permit to Operate equipment; Only qualified person to operate radioactive equipment; Cordon and restrict entry to the
area; Danger signs and safety instruction
Refrigerant (ODS) leakage Service Shop’s DTI-accreditation; TESDA-certification of Technician; Use of recovery equipment; Good Practices on
Refrigeration/ Air-conditioning
Struck/ Pinned by loose/ uncontrolled hard/ Secure lock of rolling equipment; Install guards to moving/ rotating parts; Danger signs and safety instruction; Use of
sharp parts/ objects appropriate PPE (safety hat, safety shoes)
Toxic fumes/ vapors/ gases Additional ventilation; Use of appropriate PPE (mask, respirator, protective clothing)

Trapped in confined spaces Implement procedure for confined spaces, including “Buddy” system; Safety test for oxygen & other gases; Adequate
lighting, ventilation and communication equipment
Usage of chemicals Provision of secondary containment/ catch pan; Proper work procedure and supervision; Use of appropriate PPE
(gloves, goggles)
Usage of electricity, water, paper and other Observe Resource Conservation Programs: Recover, Re-use and Recycle; ENERCON Program; Turn off faucets and
critical resources other water outlets when not in use; Report leaking and damage faucets, plumbing, other leaks to Plant Facilities
Vehicular/ Mobile equipment accident Observe prescribed speed limit, use designated vehicle lanes, defined pedestrian lanes
Others, please specify

NOTES:
1. For new environmental aspect or OHS hazard, conduct risk assessment according to the established procedure on EAISE and/ or OHS HIRAC.
2. Activities with asterisks (**) shall require additional specialized permit, i.e., Electrical Permit, Confined Space Permit, Hot Work Permit, Mechanical Permit, Working with
Height, etc
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 JOB TO BE DONE WORK PLACE SAFETY PRECAUTIONS/PPE TOOLS & EQUIPMENT NEEDED
Fire Extinguisher Respirator
Standby Fire Hose Ear Muffs/Ear Plug
Warning Sign Airline with Blower
Road Closures Safety Gloves
Cordon Safety Shoes/Boots
Lightings Face Mask/Shield
Helmet Safety Belts
Goggles/Eye Protector Cover-Alls
Apron Others
Hot Work Permit Required (see attached)
PEOPLE ON THE JOB

Legal requirements, if any:

1) 2) 3)
3. The above project is permitted, provided the specified requirements are satisfied/accomplished. Violation of the safety requirements listed in this permit shall be a cause to
stop the work and revocation of this permit. The Project In-Charge of the Contractor shall agree to the safety control measures, as applicable. All works are to be properly
supervised. BE SAFE & PROTECT THE ENVIRONMENT!

Contractor Supervisor: FLSM/OE/DE: Dir of Engineering / ACE: Security Manager:

CONTRACTOR’S EXIT PASS

TO : Security Department Date :________________________________

From : Engineering Department

ACCOMPLISHMENTS/STATUS AUTHORIZED/INSPECTED BY
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7

OPEG-446-14F4 (15 July 2013)

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