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    PTW Form Predsol

    Uploaded by

    Namig Babazadeh
    This document is a site permit to work form that contains information about a proposed work activity. It includes sections to identify the work, describe potential hazards, list required safety precautions, and obtain necessary approvals. The form documents details of the work, equipment used, hazards identified, required PPE and controls. Managerial staff must sign off to approve the permit before work can begin. Their signatures validate the permit and safety plans in place.

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

    PTW Form Predsol

    Uploaded by

    Namig Babazadeh
    12 views2 pages
    This document is a site permit to work form that contains information about a proposed work activity. It includes sections to identify the work, describe potential hazards, list required safety precautions, and obtain necessary approvals. The form documents details of the work, equipment used, hazards identified, required PPE and controls. Managerial staff must sign off to approve the permit before work can begin. Their signatures validate the permit and safety plans in place.

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    Ptw Form Predsol

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    This document is a site permit to work form that contains information about a proposed work activity. It includes sections to identify the work, describe potential hazards, list required safety precautions, and obtain necessary approvals. The form documents details of the work, equipment used, hazards identified, required PPE and controls. Managerial staff must sign off to approve the permit before work can begin. Their signatures validate the permit and safety plans in place.

    Copyright:

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

    PTW Form Predsol

    Uploaded by

    Namig Babazadeh
    This document is a site permit to work form that contains information about a proposed work activity. It includes sections to identify the work, describe potential hazards, list required safety precautions, and obtain necessary approvals. The form documents details of the work, equipment used, hazards identified, required PPE and controls. Managerial staff must sign off to approve the permit before work can begin. Their signatures validate the permit and safety plans in place.

    Copyright:

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

    SITE PERMIT TO WORK FORM

    COLD WORK HOT WORK PTW No


    CHECKLIST FOR (If any of) CL No
    SECTION 1 WORK IDENTIFICATION AND DESCRIPTION: T BE IDENTIFIED BY - PERFORMING AUTHORITY(SM)
     COLD  HOT  TSF DEM/INST  CONFINED SPACE  ELECTRICAL  MECHANICAL
     ROAD INTERR.  EXCAVATION  SCAFFOLD  WORK PLATFORM  RADIOGRAPHY  WORK AT HEIGHT
     CRANE/LIFT  CRANE / LIFT  PRESSURE TEST  ABRASIVE BLASTING  PRE-COM  OTHER
    ASSOCIATED DOCUMENTS
     METHOD STATEMENT  TRA  COMPETENT PERSON  MSDS (SDS)  P&D
     LIFTING PLAN  UNDERGROUND MAP  SCAFFOLD STUDY  PLOT PLAN  OTHER
    PERFORMER: AREA / LOCATION: RECEIVER:

    BRIEF DESCRIPTION OF PROPOSED WORK: LOCATION, ITEM, EQUIPMENT, DURATION, OTHER DOCUMENTATION
    WORK INCLUDES THE USE OF THE HIGHLIGHTED BELOW EQUIPMENT& TOOLS – SECTION SUPERVISOR
     CRANE/LIFTING  ELEVATING PLATFORM  SLINGS / CHAINS  LADDER  VEHICLE/TRUCK
     EXCAVATING  WORK BASKETBALL  SCAFFOLD  FLAME CUTTING  CHEMICAL
     PNEUMATIC TOOLS  CHAIN BLOCK  FORKLIFT  THERMAL TREATMENT  ELECTRICAL TOOLS
     VACUUM EQUIPMENT  DRILLING MACHINE  HAND TOOLS  GAS CYLINDER  MECHANICAL TOOLS
     GENERATOR  WELDING EQUIPMENT  COMPRESSOR  CONCRETE PUMP  OTHER
    POTENTIAL HAZARDS IDENTIFICATION – SECTION SUPERVISOR
     COLLAPSE  FALLING OBJECTS  HIGH NOISE  MOVING OBJECTS  HYDROCARBONS
     FALL FROM HEIGHT  SUSPENDED LOAD  HIGH TENSION CONTACT  SHARP CONTACT  SLIVER PROTECTION
     CABLE MANAGEMENT  DROWN  ASPHYXIA  RADIATION  BURN
     FIRE EXPLOSION  PRESSURE/VACUUM  TEMPERATURE  CHEMICALS  COSHH
     HARMFUL CONTACT  BREATHING DANGER  POTENTIAL GASES  CRUSH MOVING OBJECTS  SIMOPS
    GENERAL SAFETY PRECAUTIONS – ISSUING AUTHORITY (S)
     MANDATORY PPE  LIFTING ACTIVITIES  HOT WORK ACTIVITIES  WORK AT HEIGHT  ERT INFORMED
     HELMETS + CHIN STRAP  PLANNING  SAFE OF WORK AREA  COLLECTIVE PROTECTION  EMERGENCY EQUIPMENT
     SAFETY GOGGLES  RIGGING ARRANGEMENT  FF PRECAUTIONS  INDIVIDUAL PROTECTION  HOUSEKEEPING
     EARPLUGS  WEATHER CONDITIONS  LIGHTING  WARNING SIGNAGE BARRIERS  FIRE PRECAUTIONS
     FACE SHIELDS  VARIOUS FAILURES  SAFETY SIGNS  OVERHEAD POWER CABLES  PRESSURIZED EQUIPMENT
     TYPE OF GLOVES  OVERLOADING  EYE WASH SOLUTION  ERA (EM. RESCUE ARR-T)  STORAGE
     STEEL BOOTS  COMMUNICATION  VENTILATION  LADDER / TRESTLES  WASTE DISPOSAL
     RESPIRATORY PROTECTION  PERSONNEL INVOLVED  FIRST AID KIT  SCAFFTAGS  LABELING
     SAFETY HARNESS  DROPPING OBJECTS  SAFE HANDLING  MANUFACTURER'S MANUAL  MACHINERY GUARDS
     VESTS, JACKETS  "LINE OF FIRE"  CABLE MANAGEMENT  HANDRAILS / TOE BOARDS  SAFE WORK PROCEDURE
     COVERALL  (MBD / EBD) OF CRANE  USE OF GAS CYLINDERS  INSPECTION CERTIFICATES  ROTATED, MOVING PARTS
     SPECIAL COVERALL  TRAPPING / HITTING  BAD WORK POSTURE  HARNESSES  MANUAL HANDLING
     DUST / OR SPECIAL MASKS  AREA CONDITION  OTHER (specify)
     SLIPS / TRIPS / FALLS
     RESCUE EQUIPMENT
    PERMIT-TO-WORK VALIDATION SHEET
    APPROVALS / SIGNATURES PTW PARENT PTW CLOSED OUT
    NAME SURNAME POSITION DATE TIME DATE TIME
    PERFORMING
    AUTHORITY(SM)
    SECTION SUPERVISOR (SS)
    ISSUING AUTHORITY (S)
    PTW CO-ORDINATOR
    PERFORMING AUTHORITY(SM) – site manager SECTION SUPERVISOR (SS) – site supervisor ISSUING AUTHORITY (S) - work supervisor
    PERMIT REVALIDATION
    Date / Time Name / Position Signature Date / Time Name / Position Signature Date / Time Name / Position Signature

    Date / Time Name / Position Signature Date / Time Name / Position Signature Date / Time Name / Position Signature

    PERMIT CANCELLATION
    CANCELLATION REASON CANCELED BY WHOM NAME / POSITION DATE/TIME SIGNATURE

    [Document title] REV.00


    SITE PERMIT TO WORK FORM

    [Document title] REV.00

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