PERMIT TO WORK Doc No.

:
BDCM-POPS-F-001 Revision 5.1
(PTW) FORM Page: 1 of 10

Kindly read the terms and conditions of this Permit to Work Form issued by Bridge Data Centres Malaysia Sdn
Bhd (BDCM). All details requested in this form must be provided and completed. Insert “N.A” where details
requested are not applicable. This application may be rejected if insufficient or inaccurate details are given.

Please specify the location for works to be conducted as reference below:

SITE MY01 MY02 MY03 / MY06

LEVEL :
ROOM / AREA :

A) PARTICULARS OF APPLICANT

Company: PMX Malaysia Sdn Bhd Tel No:

Address: Phase 2, Data Centre, Bridge Data Center Malaysia III Sdn Bhd, Mukim of Bukit Batu,
Kulai, Johor

Applicant Name: VA L L I AP P A N Applicant Tel No: +65 81384625

Applicant IC No/Passport: S 9 0 7 1 3 7 4D

Site Supervisor Name: Site Supervisor Tel No:

BDCM PIC Name: BDCM PIC Tel No:

Particulars of the workers:

No. Name of workers NRIC/Passport No.

1
2
3
4
5
6
7
8
9
10

Note: Attach separate sheet if space provided is insufficient.

Facility: Level: Room / Area:

Date of Work: Start Date End Date:

Time of Work: Start Time: End Time:

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B) WORK CLASSIFICATION: (PLEASE INDICATE “X” IN THE TABLE BELOW)

Electrical Services Fire and Security

UPS Hose reel, CO2, Sensor
Electrical Distribution Board Water Mist, HSSD
Card Access System/CCTV
Mechanical Services
Elevator/Lift Builders Work
A/C and Ventilation System Interior Fittings
Genset Painting Works
Partitioning Work
Plumbing
Cold Water
Others (please Specify): Jacking Of DX unit

Briefly explain work methodology: (e.g.: Work at height using scissor lift, use Oxy welding, use mobile scaffolding to
repair CCTV, repair streetlight by using skylift).

LOTO: WAH: HOT: OTHER:

EHS Requirements:

1. LOTO is required whenever any work activity involved with live electric supply and operation
machineries
2. LOTO also required if operation or system involved with gas, air pressure, temperature shut down or
turned off for service
3. Work At Height (WAH) is required whenever any work activity at height (more than 2m height), by using
ladder, scaffolding, scissor lift, skyjack, boom lift or sky lift.
4. HOT work is required whenever any work involved with oxy-acetylene welding, arch welding, metal
cutting, grinding, or drilling task or using flammable material or explosive substance. Hot spot/surface is
generated from the activity.
5. Others, such as work in confined space, deep well, narrow space, required special preventive measures.
6. Multiple PTW may be required if involve various work hazard or unsafe condition.

We will take the maximum precautions to be taken and it is our responsibility to ensure safe work practices are
observed including the use of Personal Protective Equipment (PPE) required for the job. Please refer to the
appendix below for a list of required Personal Protective Equipment (PPE).

Signature of Applicant Signature of Facility / Operation

Head
VALLIAPPAN
Name of Applicant Name of Facility / Operation Head

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C) OTHERS – SECURITY DEPOSIT

Bank Name: Draft No:

Amount:

Note: The amount of the security deposit is set at 5% of the contract value or RM2,000.00 whichever is
higher.

D) SERVICES REQUIRED FROM BDCM

1) Power Shutdown

Level :
Area : _
Date :
Time : From: To:

2) Personnel Required for Standby:

□ Chargeman ☐ Security ☐ Project Coordinator ☐ Not Applicable

APPLICANT’S DECLARATION:

I HAVE READ AND FULLY UNDERSTOOD THE TERMS AND CONDITIONS. I ACCEPT AND SHALL
ABIDE BY ALL THE TERMS AND CONDITIONS STATED HEREIN.

PROJECT ENGINEER
Applicant’s Signature: Designation:

Company Stamp: PMX Malaysia Sdn Bhd Date:

FOR BDCM TENANT USE (To be filled by person authorizing the work)

We confirm that the above-mentioned company will be performing work for us and the estimated time to
complete will be days. We further confirm that we shall be liable for the performance of the
Contractor and adherence of the Contractor and its workers to the Terms and Conditions of this
Application.

Name: Signature: Date:

(Official stamp)

Tel No: Estimated completion period: days

DOCUMENT CHECKLIST

Drawing ☐Yes ☐ No Completed Form ☐Yes ☐ No

Schedule ☐Yes ☐ No

Deposit ☐Yes ☐ No

Insurance ☐Yes ☐
No

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FOR BDCM BUILDING MANAGEMENT USE ONLY

PTW Number: / /

Approval to enter critical area or Mechanical rooms:

Chargeman’s Approval:

Approval to shutdown incoming power:

Work permit validity: From: To:

BDCM Security Department:

(Signature, Date and Stamp)

Building Manager’s: Approved / Not Approved

(Signature, date and Stamp)

Extension of Work Permit: From: To:

Building Manager’s: Approved / Not Approved

(Signature, date and Stamp)

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(TO CHECKED BY BDCM[PIC&EHS]- ONCE CONTRACTOR ONSITE)

E) CONTRACTOR SAFETY COMPLIANCE CHECKLIST

1. Contractor Information:
Name of Contractor: PTW Number:
Company: PMX Malaysia Sdn Bhd Contractor/Supervisor H/P no:
Work to begin (date & time): BDCM Project Engineer:
Description of work:
Area/Room:
Not
2. Safe Work Requirement (Before Entering): Yes required
1. Is safety induction training provided? ☐ ☐
2. Is competency valid? e.g.: mobile crane, scaffolder, welder, chargeman.
☐ ☐
Man 3. Is work permit / i-card valid? CIDB green card (submit photocopy).
☐ ☐
4. Is RTK-Ag Self-Test Result provided?
(Submit copy for new and individuals returning from medical/sick leave).
☐ ☐
1. Is PMA, driving license valid? (Submit photocopy) ☐ ☐
Machine
2. Is chain sling/ wire rope tested? (Submit photocopy) ☐ ☐
(e.g.: Mobile crane, Forklift) 3. Is powered tool in good /safe condition? Grinder, Cutter, Driller etc. ☐ ☐
4. Is Nonconductive platform ladder in condition?
☐ ☐
1. Is Method of Statement submitted MOS)? (Drawing, calculation, flowchart) ☐ ☐
2. Is HIRAC/JSA provided, reviewed and approved? ☐ ☐
Method 3. Is CCF approved? ☐ ☐
4. Is PTW (LOTO, HOT, WAH) required & approved?
☐ ☐
1. Is chemical (flammable/combustible) safely handled/kept? ☐ ☐
Material 2. Is chemical MSDS/SDS provided? (Submit photocopy) ☐ ☐
3. Is material properly secured and stored? Eg Not obstructing path and traffic
☐ ☐
1. Is unsafe condition/ hazard safeguarded?
e.g.: deep excavation, manhole, heavy object, sharp object, hanging
☐ ☐
object, loose object at height, slippery ground ☐ ☐
Workplace 2. Is affected work area/ group notified? Is relocation required? ☐ ☐
3. Is floor protection implemented? prior to transferring material ☐ ☐
4. Is the site effectively barricaded? (eg safety cones & poles).
1. Is system or equipment safely shut down, isolated, or locked out? LOTO ☐ ☐
System/Plant 2. Is the electrician/chargeman informed? Affected system, process & location ☐ ☐
3. Is the system/machine protected from electric interruption? e.g.: ELCB/MCB
☐ ☐
Safety Helmet: Safety harness: Safety Shoes: Hand gloves:
☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No
Personal protective
equipment to be Eyeglasses: Ear plug/muff: Safety Vest: Respirator (eg N95, Half face):
worn: ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No

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Checked By: EHS Manager

Name Signature Date

3. Acknowledged by Contractor
Safety Work Commitment & Declaration:
1. All work will be conducted in a safe manner, by using safe tools/machine, with maximum safe work practice, minimal hazard & lowest risk.
2. All contractors/technicians who perform this task have been given safety training and technical competence to do the job.
Hereby I agree to comply with all safety precautions and responsibility in every incident pertaining to my act. We fully agree and accept the penalty
imposed by BDCM, if we fail to comply to BDCM safety requirements.

Name Signature Date

4. Checked by relevant parties during work or after work completion (Exiting)
Check Items Checked by Contractor/Supervisor Accepted BDCM Project
Engineer
Is work/installation completed with good quality & workmanship?

Is unsafe condition/hazard safeguarded?

Is the temporary shutdown normalized/altered setting restored?
Is installation safely tested/commissioning?
Is housekeeping done/waste properly disposed?

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A. TERMS AND CONDITIONS OF WORK APPLICATION

The BDCM is a secure facility. As such, we seek your cooperation in ensuring that all work procedures and
guidelines as well as security measures are at all times adhered to strictly. This Permit to Work (PTW) Form is
issued to the contractor to work only at the specified location(s) subject to the following terms and conditions.
It is issued only to contractors who have been duly approved by Tenants of the BDCM authorized by BDCM
Building Management:

1. All workers shall wear and display the BDCM Worker’s Pass while in the work area. Any worker
found to be without a pass will be removed from the site immediately. The supervisor shall produce
the original copy of the approved permit to work when requested to do so by BDCM Building
Management or BDCM Security personnel, failing which the supervisor and the workers will be
removed from site immediately.
2. Prior permission must be obtained from BDCM Building Management for any work which requires
power shutdown. Prior approval shall be obtained from BDCM Building Management at least five (5)
working days if any of the above activities is deemed necessary.
3. Contractors MUST submit all the relevant documents including the layout plan, work schedule, single
line diagram, approved drawing from the customer and brief BDCM Building Management of the
work involved before carrying out any work in the building.
4. Work at the specified location(s) is allowed only during normal working hours (from 09:00AM to
05:00PM for Monday to Friday inclusive) or the time shown in the work application. Any extended
working hours can be allowed after getting written confirmation from BDCM Building Management.
5. All items including but not limited to structures, equipment, installations, and systems are deemed to
be cleaned and in good working condition prior to the contractor starting work on the floor where
access is permitted. A contractor can be held liable if any item deemed to be in good working
condition prior to him having access to the floor is found to be faulty or damaged after the contractor
has accessed the floor or has commenced work.
6. The contractor shall take all precautions to avoid causing any damage or stain to the wall/floor,
equipment, installations, structures, systems of the building during working, delivery, loading and
unloading. The contractor shall be charged for any rectification work to make good the damage or
stains caused by him.
7. Contractors are PROHIBITED from changing the status of any fire alarm system, fire-fighting
equipment and their associated parts or using the firefighting system for other purposes. A fine of
TWO THOUSAND RINGGITS (RM 2,000.00) will be imposed each time the contractor triggers a
false alarm.
8. BDCM is a non-smoking area. Any contractor who is caught smoking on the premises will be fined
FIVE HUNDRED RINGGIT (RM 500.00) each time.
9. Contractors shall ensure that all staircase doors and service lift lobby doors on the level(s) they are
working on are always kept closed. Any worker found violating this rule shall be removed from the
site immediately.
10. Prior permission shall be obtained from the tenants before entering their premises.
11. Prior permission shall be obtained from the tenant of the floor before using any facilities on that floor.
The facilities include toilets, electricity, workstations, communication equipment, kitchenware,
kitchen utensils, furniture, and the likes.
12. Contractors found in possession of key(s) that can open the lock of any door, panel, or cabinet in the
building without proper authorization shall be handed over to BDCM Security Department for further
action.
13. Contractors are STRICTLY PROHIBITED from taking any food, drinks, cigarettes, lighters and/or
match sticks into the critical area or mechanical rooms. Any workers found with such materials in the
critical area or mechanical rooms shall be fine One THOUSAND RINGGIT (RM 1,000.00) and
removed from site.
14. Prior permission shall be obtained from the building manager to enter any mechanical floor. Entry
into mechanical floors is restricted to working hours only (09:00AM to 05:00PM) unless prior
permission is obtained to enter the mechanical floors after working hours.
15. All materials, containers, tools, equipment, covers, boxes, wrappers, packing, scaffolding and the like
brought into the work area shall clearly bear the contractor’s company name on a conspicuous part of

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the item for easy identification. Any item that does not clearly and conspicuously bear the company’s
name will be considered as unclaimed material and shall be removed as debris without notice.
16. Drilling, cutting, or covering of any openings of any description on any part of the building structure
or load bearing structure is NOT allowed. Prior approval shall be obtained from BDCM Building
Management if any of the above activities are deemed necessary.
17. Any drifting dust, rubbish, unwanted material around the work site shall be cleaned immediately,
failing which the cleaning works may be done by BDCM Building Management appointed cleaners
and all costs incurred shall be deducted from the deposit and/or charge to the contractor.
18. Garbage and debris shall be transported out of the building daily, failing which BDCM Building
Management may remove the garbage and/or debris and all costs incurred shall be deducted from the
deposit and/or charge to the contractor. Leftover food, food and drink containers must be disposed of
in rubbish bins.
19. Contractors are PROHIBITED from using the passenger lifts unless prior permission is obtained
from BDCM Building Management.
20. Use only the service lift, back staircase or loading area for transporting any equipment, material, tools,
ladders scaffolding, construction debris, rubbish, machines, chemicals, or the like.
21. The loading and/or unloading of materials shall be at the designated loading bay, contractor should
collect safety harness from BDCM Building Management before carrying out the work. Prior
arrangement must be made with BDCM Building Management on the time and duration of
loading/unloading.
22. All forms of nuisance but not limited to the following shall be controlled: - noise, noxious fumes,
major impact on the slabs and walls, drifting dust, excess fluid. Any worker found violating this rule
shall be removed from the site immediately.
23. Contractors are prohibited from carrying out any mass production works such as mass fabrication of
parts, mass shaping or mass spray painting of parts or joinery works, furniture works on the floor.
24. A TWO THOUSAND RINGGIT (RM2,000.00) Deposit or sum equivalent to 5% of the contract
value whichever is higher in the form of a Bank Draft or Company Cheque and made payable to
“Bridge Data Centres Malaysia Sdn.Bhd” is required for applications by ad-hoc contractors. BDCM
reserves the right to cash the Deposit to settle any cost incurred by BDCM for making good damages
caused by the contractor and shall make further claims if the deposit is insufficient. Contractors are
required to top up their Deposit within 3 days if the balance is less than 50% of the Deposit. BDCM
reserves the right to stop works if not complied. The Bank Draft or Company Cheque will be returned
to the Contractor within 30 days of the Contractor completing the work.

25. The following rate/charges are applicable:

Personnel Rate/hour (min. hours)

1
(9:00am to 5:00pm) (5: 00pm to 9:00am)
Security RM 100-00 RM 150-00
Chargeman RM 300-00 RM 450-00
Engineer/Project Coordinator RM 400-00 RM 600-00
Please note that the charges will apply where BDCM personnel are
required.

26. The terms and conditions stated herein and any details such as telephone numbers provided in this
PTW form are subject to changes without prior notice. BDCM Building Management reserves the
right to request additional information pertaining to this application.
27. This PTW is automatically cancelled if any of the contractor’s workers, supervisors, agents, or
representatives violates any term and/or condition and they will be removed from site immediately.
28. Contractors are PROHIBITED from taking any photos from BDCM building premises. Any workers
found taking photos will be fined FIVE THOUSAND RINGGIT (RM 5,000.00) and removed from
the site.

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B. COVID – 19 Compliances – (As Government guideline)

1. The contractor should submit the workers for minimum Covid-19 swab tests and only the negative
test result workers approved to enter to BDCM facility. The test results shall be completed within
24 hours prior to entry / commencement date.
2. The contractor worker only allows to use dedicated walkway.
3. The contractor shall provide proper hand sanitizer and face mask to their workers.
4. All contractor employees must wear face masks within BDCM.
5. Any contractor displaying flu like shall be refused to enter BDCM unless a medical report is issued
and reflects fit for work.
6. BDCM will dedicate a place for storage, lunch, and toilet. Contractor worker must adhere to it.
7. A self RTK-Ag Test must be completed if any of the contractor workers has been identified as
Covid- 19 close contacts.

C. EHS (Environmental, Health and Safety)

1. Evacuation Procedures
In the event of an emergency, it might become necessary to evacuate the building. All occupants
should be completely familiar with the following evacuation procedures:
 In an emergency, proceed to the nearest emergency exit door and refer to the evacuation route.
 If you are directed to evacuate, follow the instructions of all Security/Fire Warden’s.
 Familiarize yourself with the location of all hallways and emergency exits. If a hallway is
blocked, proceed to an alternate hallway.
 Use safe stairwell exit procedures; remain calm and quiet, remove high-heeled shoes, exit in a
single line, keep to the right, and use handrails, moving quickly but do not run.
 Assist injured occupants and others who might have trouble on the stairs and treat injuries on
stairwell landings only when it can be done safely.

2. Minimum recommended approved PPE (Personal Protective Equipment) prior entering

BDCM Facility.

Mandatory Additional
Task Protective Equipment Protective Equipment
- Safety Glass
Dirty / Dusty Environments - Fabric Gloves
- Half face Respirator
- Electrical Insulated Gloves
Electrical Works - ELCB/ MCB
- Fiber glass platform ladder
- Safety Helmet - Safety Glass
* Must be approved by - Chemical Resistant gloves
Chemical Handling SIRIM Malaysia. - Chemical resistant clothing
- Safety Boots - Half face respirator
* Must be approved by - SDS - Safety Data Sheet
SIRIM Malaysia. - Welding Face Shield
Light Radiation - Safety Glass (IR & UV) Protection
(Welding Operations, Laser Operations) - Safety Vest - Welding Glove
- Half face Respirator
Heights (>1.8 m) - Full Body Safety Harness
Physical hazard (hand)
e.g.: sharp edge - Cut resistant hand gloves
Excessive noise activities / - Earplugs
workplace e.g.: >80 dB(A) - Earmuffs

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D. BDCM EHS Rules

i. General
1. Daily pre task analysis and briefing must be completed before commencement
2. Inspect and ensure all personnel have the required PPE and always worn while on site
3. Inspect equipment and tools for defects before using them.
4. Only authorized and certified operators can handle potentially dangerous equipment.
5. Trailing cables must be taped down, or cones must be placed to alert others to tripping hazards.
6. Loose clothing is not allowed, and long hair and beard must be secured or covered to avoid
entanglement hazards, especially when working near moving or rotating equipment.
7. For safety reasons, contractors with Bermuda/short pants and slippers will not be allowed to enter the
premises.
8. Prior disclosure to BDCM Building Management and prior permission must be obtained from BDCM
Building Management before any hazardous, toxic, corrosive, volatile or highly flammable material,
chemical, gas volatile organic compound such as but not limited to thinner, turpentine, detergent,
acetylene, methane, propane, petrol, kerosene is brought into the building. At the sole discretion of
BDCM Building Management such material, if not stored or handled properly, shall be removed from
the building without notice.
9. All hazardous/scheduled waste shall be with evidence disposed of properly and in compliance with
local regulations.
10. Contractors shall avoid manual lifting by using mechanical devices to lift and transport heavy objects
whenever possible.
11. If unable to use mechanical devices, ensure that workers receive the required manual handling
training to remind lift with their legs, not lift with their back to avoid back injuries.
12. All workers shall be closely supervised by the contractor’s supervisor whose name appears on page 1
of this work application.
13. Contractors shall be responsible for the safety of their workers and shall not expose the occupants of
the building and the public to any health, safety and security risk when carrying out any work.
Contractors always have insurance coverage for the work to be performed and associated insurance
for their workers.
14. Safety signage and hoarding/barricade shall be installed to the satisfaction of BDCM Building
Management before any work can commence. All barricade/hoarding shall display the company’s
name, applicant’s name, and telephone number. All construction materials on site shall be stored in a
safe manner. If the works are to be carried out in a public area, a sketch showing the proposed
hoarding and barricade shall be submitted.
15. Contractors shall be equipped with proper safety equipment and rubbish bin for their work conducted.
16. If the works are to be carried out on or near marble and/or granite floor, the floor shall be protected
with plastic sheets placed over a gypsum or plywood board base. Plywood shall not be used for
protection works that require a hot work application.
17. Ensure safety hazard/caution tape installed at workplace.
18. Use cut resistance gloves when work scope related to sharp edges parts.
19. Usage of pallet jack/crane/forklift shall not exceed 70 % of handled material weight.
20. Anti-slip mat shall be used as floor protection to avoid any slip hazard.

ii. Electrical
1. Prior permission shall be obtained from BDCM Building Management to work on any electrical
panel or tap power from any power point.
2. All the extension cord shall be equipped with 100 mA RCBO.
3. Any electric power tapped from the building shall be done through a portable distribution board that
has an RCBO rated at 0.1A or less. Failure to comply will result in a work stoppage and fine of ONE
HUNDRED RINGGIT (RM 100.00) each time.
4. Only non-conducting ladders are allowed for work involving electrical hazards.

iii. Mechanical
1. A maximum of 4 raised floor tiles can be opened at a time and shall be cordoned off. (If applicable)

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2. Before beginning work, ensure that certified or licensed personnel are validated to handle
forklifts, cranes, gondolas, and scaffolding.

- Use appropriate lifting rope/hoist for any material handling on height.

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