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    Permit To Work Form CMC

    Uploaded by

    Waqas Haider
    work permit format

    Copyright:

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

    Permit To Work Form CMC

    Uploaded by

    Waqas Haider
    5 views1 page
    work permit format

    Original Title

    Permit To work Form CMC

    Copyright

    © © All Rights Reserved

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    DOC, PDF, TXT or read online from Scribd

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    work permit format

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    5 views1 page

    Permit To Work Form CMC

    Uploaded by

    Waqas Haider
    work permit format

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 1

    Doc CMEC-HSE-PR-

    No. 15-F-009
    Permit To work Form
    Rev
    00
    No.
    PTW Control No Date / Time
    Location & Coordinates Shift Day / Night
    MS & RA Ref number Project Name / Company
    Name of Permit Receiver Designation of Permit Receiver
    Contact Number (Mobile) Emergency contact information
    Sub-contractor HSE
    Name of Permit Issuer Designation of Permit Issuer
    Contact Number (Mobile) Emergency contact information
    CMEC HSE
    Employee In-charge at work Number of Employees working at site
    site & Contact Number
    Plant & Equipment’s used
    Permit valid from (Date) __________ (Time) ___________ hrs. to (Date) ___________ (Time) ____________ hrs.
    Type of work permit required Cold Work Permit Excavation Permit Critical lifting permit
    Hot work Permit Electrical Permit
    Description of Job

    Requested by Sign: Date & Time Approved by Sign: Date &


    (Permit Receiver) (Permit Issuer) Time
    Remarks Remarks

    Acknowledged by CMEC Sign: Comments:


    PTW coordinator
    Name: Date & Time:
    Hazards of Worksite - Field Assessment by Sub-contractor HSE
    Collapse / fall of load / Excavation associated
    Restricted access & Egress Slip or trip Heavy Manual Handling
    material hazards
    Fire Hazards Heat or cold Struck by object Waste generation Fall from height
    Electrical hazards Noise Rain / Mist Isolated work Dangerous specious / insects
    Mechanical hazards Illumination Dust / Sand storm Vehicle Movement Vehicle movement
    Additional HSE Hazards if any assessed on field (To be field by Sub-contractor HSE):

    Hazard Controls Required -Field Assessment by Sub-contractor HSE


    PPE compliance Waste segregation & house Standard scaffolding & ladders First Aid Kit & first aider Appropriate material stacking &
    keeping storing
    Sloping / benching / shielding Effective illumination Water, Rehydration drinks Desert Kit Competent supervision
    Dust control measures Noise control Measures Waste management Training and awareness Vehicle inspection / maintenance
    Effective barricading & Lifting Plan (Additional sheet Emergency standby vehicles Cable Management
    Signage’s required)
    Fire prevention & Protection Lock out / tagout (Additional Buddy system Fall protection &
    measures sheet required) Prevention
    Additional HSE mitigation measures initiated on field (To be field by Sub-contractor HSE)

    Declaration by Lead Work Party & Sub-contractor HSE


    Hereby we confirm that, safety mitigation measures as declared in risk assessment as well as through this permit is implemented and continuous monitoring of the same shall be
    ensured for its sustainability.
    Sub-contractor Lead work Date & Sub-contractor HSE Name & Date &
    party Name & Signature Time Signature Time

    Permit Renewal by Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7


    Permit receiver Start End Start End Start End Start End Start End Start End Start End
    Time Time Time Time Time Time Time Time Time Time Time Time Time Time
    Date
    Signature

    Permit closure on job completion / permit expiry


    Permit Receiver CMEC Permit Issuer
    Name Signature Name Signature
    Date: Time: Date: Time:
    Stop work notice by EPZR
    Reason for Permit Cancellation: Name & Signature with date:

    PTW form Page 1/1

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