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PATOS FORM MDC-EHS-0006

Activity/Task WATERPROOFING OF CISTERN AND HOLDING TANK WORKING IN CONFINED SPACE


DAVIES
MDC - AVIDA 9th Avenue corner Lane S,
Date Company TECHNICAL Project Location
TOWER TURF Bonifacio Global City
SOLUTION INC.
Complete the PATOS Questionnaire
If a hazardous substances / chemicals is to be used, do you have the MSDS available? NO YES
Equipment & Tools to be used: Scaffolding, SafetyHarness, Lights & Extension cord, Blower (in & out), Exhaust
Hose, Tampico Brush, Steel Brush, Electric Mixer

Does the task require a permit or other document approval? NO YES Indicate which

Excavation Permit Confined Space Permit Isolation Permit Lifting Permit


Working Near Overhead Power LinePermit Working at Height Permit Hot Work Permit Demolition
Works Permit Formwork Inspection &Concrete Pouring Permit Gondola Operations
Scaffold Inspection and tag
Logical Steps in Task Unwanted Event / Hazard What controls are required to manage the Is the hazard
(What could go wrong,) hazard? controlled
(Consider Hierarchy of Controls) adequately?
Have a engineering/management Discuss & record it on paper. YES
meeting. Raise permits
Inspection of work site Slip , Trip, Fall Remove all waste materials from the YES
work site. arrange the materials in good
fashion order.
Open tank May be full of fluids, gas or low oxygen lid Stand clear when opening the tank, have YES
may blown off. fresh air blowing over worksite.

Build barrier & clear tank People falling in hole before barrier Have barrier in place if possible before YES
complete, clearing gases may be toxic opening tank, test air coming out & be
prepared for foul air/fluid.

Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy

Only Authorized Printed Version Is Deemed To Be ControlledPage1 of 5


Trained & Competent assistant Person being given another job, wandering Ware proper PE's. Pre job training YES
off , not being trained entering the tank to reinforced be the person entering the
assist/rescue. tank.
Test air/gasses Unfamiliar with safe level of Person should read permit if unsure YES
O2/gasses/misreading, faulty calibration consult the Safety Manager/Engg in
charge, check calibration date and check
calibration
Entering Tank Falling while climbing ladder/scaffold or trip Fall protection and Good lighting YES
on debris inside space.
Start the work you agreed to do in Another job may be necessary Have another meeting check permit, keep YES
the time you also agreed on the man outside fully informed
Complete the task, removed all Job not completed, equipment left in the Double check what was agreed on, YES
equipment space inform PIC if the job is incomplete. check
list of tools retained by watcher.
Secure tank, close permit Next crew may not be fully aware of what is Stick to permits condition and time YES
happening
Pre – Entry Lack of Communication Plan the work involving personnel YES
responsible for preparation (isolation,
depressurization, draining, venting,
flushing, purging, gas testing etc) of
confined space.
Energized Equipment Ensure the Confined Space is
positively isolated from all sources of
energy(hydraulic, pneumatic, electrical etc.)
Pressurized Fluid Ensure the confined is depressurized &
content is drained safely.
Flammable & / or ToxicAtmosphere Ensure the confined space is flushed, purged
and thoroughly ventilated as required.
Lack of Oxygen Ensure the confined space is free from
any flammable /toxic atmosphere
and has sufficient oxygen for normal
breathing.

Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy

Only Authorized Printed Version Is Deemed To Be ControlledPage2 of 5


Unauthorized Entry Obtain the entry permit & other
associated permits for types of work to
be carried out.

Entry No Contact with the Entrant Place a Standby Person at manhole to YES
maintain contact with the entrant and
record entry / exit.
Dark / Insufficient Illumination Ensure safe illumination suitable
t o h a z a r d o u s a r e a classification
Fire & Explosion Ensure the work to be carried out
i n s i d e t h e C o n f i n e d Space fulfill the
Permit to Work requirement for the type
of work.
Heat & Humid  Ensure sufficient ventilation a
nd air circulation inside
confined space
 Provide periodic break / rest to the
entrant
Toxic Hazard  Ensure continued gas monitoring.
 Ensure cross ventilation to dispose toxic
vapor.
Entrapment or Collapse of Entrant Ensure availability of full body
harness & lifeline etc for emergency
retrieval of personnel from Confined
Space.

Re-entry /Completion Left Unattended for Re-Entry Barricade the Confined Space and post YES
warning notice.
Foreign Materials Left inside Ensure there is no tool, equipment, rags
or other materialleft inside

Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy

Only Authorized Printed Version Is Deemed To Be ControlledPage3 of 5


Orientation and sign off by all persons involved in work under this PATOS is - Before Commencing task; and
Mandatory - If additional hazards and controls have been identified
Name: Signature: Date: Name: Signature: Date:

Responsible Engineer / Jonathan Avanceña Signature: Date:


Supervisors Name: Engineering Dept. Head
EHS Approver Name: Signature: Date:
Who is person responsible to Sign off by responsible person to state that
Control actions from PATOS implement this control? controls have been implemented prior to
commencing step in task

Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy

Only Authorized Printed Version Is Deemed To Be ControlledPage4 of 5


Jonathan Avanceña Jonathan Avanceña
Engineering Dept. Head Engineering Dept. Head
Paul Joenathan Apolonio Paul Joenathan Apolonio
PIC PIC
Albert T. Balase Albert T. Balase
Safety Officer Safety Officer
Yes No
If job is still in progress or incomplete: Have you discussed this PATOS with the oncoming Supervisor?

Document Number – Title Owner Date Approved Revision Status Next Review Date
QEHS-HSE.0006 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy

Only Authorized Printed Version Is Deemed To Be ControlledPage5 of 5

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