SYCS1-Permit To Work V1

• Permit To Work No.

• PTW Description

• SITE CODE

• Performing Engineer

• Conducted on

  Date

SECTION I: Details of Proposed Work

• System/Sub-System Impacted

  Select BMS Security System Electrical Mechanical Systems Fire Systems Power Systems HVAC Backup Power Systems Generators Chiller Systems Structured Cabling Systems Piping Systems Pressure Set Pumps

  • BMS
  • Security System
  • Electrical
  • Mechanical Systems
  • Fire Systems
  • Power Systems
  • HVAC
  • Backup Power Systems
  • Generators
  • Chiller Systems
  • Structured Cabling Systems
  • Piping Systems
  • Pressure Set Pumps

• Floor Level

  Select L1 L2 L3 Mid Plant 2 Mid Plant 1 LB UB MDF ROOMS UB Roof Plant 5 Roof Plant 6

  • L1
  • L2
  • L3
  • Mid Plant 2
  • Mid Plant 1
  • LB
  • UB
  • MDF ROOMS UB
  • Roof Plant 5
  • Roof Plant 6

PROPOSED SCHEDULE OF WORK

• Proposed Schedule of Works

Start Date and Time

• Proposed Start Date and Time

  Date

• Proposed End Date and Time

  Date

Brief Description of Proposed Work

• PTW Category

  Select Scheduled Maintenance Service Callout Carrier Works Customer Third-Party Contractor Approved LAAN Works Others

  • Scheduled Maintenance
  • Service Callout
  • Carrier Works
  • Customer Third-Party Contractor
  • Approved LAAN Works
  • Others

• Please provide Cabling Licence Details

• Photographic evidence of cabling license registration details (Optional)

  Media

SECTION II: RISK ASSESSMENT

• Risk Assessment Table
  

  

• Risk Score

  LOW

  MEDIUM

  HIGH

  VERY HIGH

• Documentations Provided

  Select SWMS Maintenance Script Switch Tag Hot Works Permit Approved LAAN Certificate of Current Insurance Current NSW Work Cover Insurance Certificate Cabling License Registration Details Others

  • SWMS
  • Maintenance Script
  • Switch Tag
  • Hot Works Permit
  • Approved LAAN
  • Certificate of Current Insurance
  • Current NSW Work Cover Insurance Certificate
  • Cabling License Registration Details
  • Others

• Media/Attachments (Optional) * Due to app limitation, it is recommended to submit documents ticked above separate from this App. Please have these documentations ready when required by the Approver. IMPORTANT: All documentations provided must be current.

  Media

SECTION III: CONTRACTOR DETAILS

• Contact Details

Contact

• Full Name

• Company

• Immediate Contact Details while onsite (For emergency purposes)

Constraints (if any)

• Prerequisites before start of work(if any)

• Date and Time

  Date

APPROVAL

• Work Authorisation (Work Approval in Accordance with Section 3, above):
  The procedures, control measures and precautions appropriate for the safe execution of hot work have been implemented and the persons required to work have been advised of and understand the requirements of the Risk Assessment & Hot Work Permit.
  The personnel listed in above may access the areas identified in Section 1.
  

Cloudspace Facilities Engineer

• Signed

  Sign

Senior Management Approval

• Signed

  Sign

• IMPORTANT: Document only valid with signature from senior management.