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    General Work Permit Form

    Uploaded by

    Ahmed Gamal

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    General Work Permit Form

    Uploaded by

    Ahmed Gamal
    7 views2 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    7 views2 pages

    General Work Permit Form

    Uploaded by

    Ahmed Gamal

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    GENERAL WORK PERMIT

    PTW Ref .No: Contractor:


    Project Name: No. of Employees involved
    Starting From Date Time Expected Completion Date Time
    Activity:
    Work Description:
    Location of job to be performed:
    Tool/Equipment to be used:
    Identify risk associated with this General Work
    Fall from Height Adverse Weather Flying particles Moving Vehicle/ Equipment
    Falling Debris/ Objects Protruding objects, parts Tripping / Slipping Faulty Tool/ Material
    Noise Heat Vibration Poor Illumination
    Other (Specify):
    Precautions required to complete the work safely Yes No N/A
    Have tools and devices to be used been tested and adjusted?
    Have all hazards/hazardous related to these activities identified and assessed?
    Working at height Scaffolding Pressure Test Chemical
    Electrical Saw/Cold cut Hot Surface Tool & Equipment’s
    Dust Lifting
    Are permits associated require for this activity? if yes, mentioned below;
    Hot Work Working at Height Excavation Electrical Confined Space to Entry
    Other (specify):

    The following areas / items have been inspected by issuer and receiver
    Access/Egress Danger/Warning Sign Lighting Safety Barriers
    Hand Tools Other (specify)
    PPE Required for the activity
    Helmet Safety Shoes Safety Gloves Safety Ear Plugs/muff
    Safety goggles Reflective Vest Dust Mask Safety clothes
    Other (Specify):
    Issue and acceptance before work
    Acceptance of Work Permission by the person in-charge (Receiver)
    I certify that, I have read and verified this work permit and checklist. I am aware of the risks that can be exposed to. I commit that I will be in line
    with all safety rules mentioned in work permit checklist and will not deflect any of them.
    Permit Receiver Name: Signature/Date:
    Authority to proceed by authorized person (Issuer)
    I reviewed the work permission checklist and checked the working conditions. I have reviewed the all aspects of the task/activity and am satisfied
    with the arrangements as detailed in the “risk assessment” have been put in place and certify that the activity detailed above is authorized to
    proceed
    Permit Issuer Name: Signature/Date:
    Acknowledge by Contractor's Safety Engineer/Officer
    I have reviewed the work permit, and verified entire checklist corresponding to workplace. All the necessary control measures has been taken
    according to risk assessment and additional precautions are implemented.
    Name: Signature/Date:
    Clearance and cancellation after work or Suspension of permit
    Clearance. (Site Manager)
    All men, materials, tools equipment, housekeeping etc. under my charge have been withdrawn. The permitted work is complete / not complete.
    Name: Signature/Date:
    Suspension
    This permit is suspended, I have notified the Authorized person specified that the work is not complete the area / equipment is not safe to use.
    Name: Signature/Date:
    GENERAL WORK PERMIT
    List of additional precaution measures required (SMEP`s Safety Officer/Engr. / Contractor's Safety Officer/Engr.)

    1.

    2.

    3.

    4.

    5.

    Permit Re-Validation

    Sl. Receiver Contractor's


    Date Time Issuer Signature Remarks
    No Signature Safety Signature

    This permit is valid for 7 days from the date of issue.

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