APEX GLOBAL ENGINEERING SDN BHD (828911-T)

Attachment XXII

GENERAL ELECTRIC WORK PERMIT

1. Vessel’s Name: Date: Location:
* Permit No: Control measures as identified by : JHA
* Vsl Name /PTW/Year / Running Number: JHA Reference No:
WORK DESCRIPTION:

2. PERMIT VALIDITY (The permit will be valid for 12 hrs only . A new permit to be applied if the duration exceeds 24 hours)
Permit Start Date: Time: Permit Expires Date: Time:
The permit is automatically suspended whenever an emergency alarm is activated. Work must stop and site made safe and permit
return to source.
(Tick box as appropriate)
3. WORKING CHECK LIST YES NO
1 LOTO procedures in place and followed
2 De-energize, lockout & tagout hazards during maintenance, repair or inspections
3 Non insulated tools or equipment must be kept at least 4 feet away from energized parts.
4 Ensure tools used are electrically rated insulated tools and are in good condition
5 Drain off stored energy in capacitors.
6 Not using a 3-wire cord with a 2-wire plug.
7 Third prong (ground pin) not removed to make a 3-prong plug fit a 2-prong outlet
8 Outlets not overloaded with too many appliances
9 Cord not used to raise or lower equipment or run through walls, doors, rugs or aisles
10 Extensions cords not wrapped around electrical fixtures or ventilation pipes.
11 Extension cords not with electrical tape, or wire nuts.
12 Approved fuse handling equipment that is insulated for the circuit voltage is used.
13 Others (Please specify):

4. ISOLATION ( Tick boxes where applicable )

Instrument power supply Mechanical power supply Electrical isolation

5. SOURCES OF IGNITION ( Tick boxes where applicable )

Flame Cutting, Welding Welding Torch Igniters Chipping Sparks
Grit Blasting Explosives Others (Please specify):

6. PROTECTIVE EQUIPMENT ( Tick boxes where applicable )

Coverall/Safety helmets/Safety footwear/Safety spectacles
Ear muffs/Ear plugs Goggles/ Face visor Hood/Helmet Gloves/Gauntlets
Boots/ Chemical gloves Safety net Fire blankets Work vest/Life jacket
Safety warning signs Dust/Gas Respirator Self Contained BA Wet tarpaulin
Safety harness and lanyard Foam Ext. ( ) Dry Powder Ext. ( ) CO2 Ext. ( )

7. CLEARANCE APPROVAL
A. PERMIT APPLICANT B. APPROVAL FOR WORK SIGNATORY C. AUTHORIZING SIGNATURE
(Ch Officer or 2nd Engineer) (Master or Chief Engineer) (Master or Tech Superintendent)

I understand the precautions to be taken and I have inspected the worksite and satisfied I authorise work to commence
agree to fully comply with the Company that it has been properly prepared for the
instructions / requirements stated above. work as specified on this permit.
Sign: Date: Sign: Date: Sign: Date:
Name: Name: Name:
Rank: Rank: Rank:
Remark (if any): Remark (if any): Remark (if any):
 APEX GLOBAL ENGINEERING SDN BHD (828911-T)

8. WORK STOPPED / PERMIT SUSPENSION / RE- VALIDATION

Once work is stopped/permit suspended the application is to state the reason for stoppage/ suspension, inform the approver and
authorizer and endorse the “Work Stopped” column.
ACTION Work Stopped Work Stopped Work Stopped
Reason
Examples : (a) Unacceptable work conditions (b) End of working Day/Shift (c) Emergency alarm activated (d) Others - specify
Date:
Time:
Applicant
Sign:
ACTION Re-Validation Re-Validation
When the applicant is ready to
Date:
commence work again he has to
Time:
Applicant endorse the relevant revalidation
Sign: column. The approver is to ensure
that the worksite is still in the
Date:
conditions specified in the permit
Time:
Approver and the authorizer has to endorse
Sign: before work can resume.
Date:
If Work has been stopped 3 times
Time: then a new PTW form is to be
Authorizer
Sign: used. See Attachment 7.5.

9. WORK COMPLETION ENDORSEMENT

A. PERMIT APPLICANT B. APPROVAL FOR WORK SIGNATORY C. AUTHORIZING SIGNATURE
(Ch Officer or 2nd Engineer) (Master or Chief Engineer) (Master or Tech Superintendent)

I have stopped work. The area has been I have visited the worksite and satisfied
I am satisfied that the work has stopped
restored to a safe and operational condition. myself that the work has stopped. The area
and the area restored to a safe and
has been restored to a safe and operational
operational condition.
condition.
Signature: Date: Signature: Date: Signature: Date:
Name/Rank Name/Rank Name:
Remark (if any): Remark (if any): Remark (if any):

PERMIT DISTRIBUTION
ORIGINAL - To be displayed on the Bridge till completion and COPY – To be displayed at the worksite till completion.
Master to keep for record.