PTW Form Predsol
PTW Form Predsol
PTW Form Predsol
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