COLD WORK PERMIT
PROJECT INTERGRATED FACILITIES (PIF)
1. INFORMATION 2. RESPONSIBLE PERSON & CONTACT NUMBER 3. PERMIT NO. & WORKING PERIOD
Company: Responsible ENGINEER Name & Cellphone No: Permit Number
Location: From:
Date
Description of Work: Responsible FOREMAN Name & Cellphone No: To:
Working Hour
4. HAZARD IDENTIFICATION 5. PRECAUTIONS
Unsafe access Confined space Toolbox talk is done Machinery and equipment are checked and in good condition
Adverse weather conditon Vibration Suitable access and egress is provided Scaffold are daily checked and checklist filled
Work at height Equipment not maintained Barriers and Signs are in place All lifting devices and equipment to be examined visually
Scaffolding / Ladder Lack of communication Site traffic is under control, Signs are in place Fall arrest equipment to be visually inspected
Work with manlift UV radiation All chemicals are tagged and stored properly Workers to be aware of emergency procedrue
Fall objects Others: Manlift operator has to put appropreate mudsills under All electrical tools and cables have to be checked monthly and
Lifting operation outriggers and outriggers fully extended daily before use, color coded
Transporting Operators to have certificate on lifting equipment Fixed platform to be provided with guard and handrails
Work with chemicals 6. PPE
Lack of signs Safety Helmet Gloves Full Body Harness
Work with electrical hand tools Safety Boots Coverall Dust Mask
Poor lighting Safety Goggle Respiratory Protection Positive Pressure BA set
Noise Face Shield Hearing Protection Other:
7. ACCEPTANCE 9. CLOSURE
PERMIT APPLICANT PERMIT APPLICANT
Name: Position: Sign: Date/Time:
Name: Position: Sign: Date/Time:
□ JOB COMPLETED
PERMIT REVIEWER PERMIT REVIEWER
Name: Position: Sign: Date/Time:
Name: Position: Sign: Date/Time:
□ JOB COMPLETED
PERMIT ISSUER (HSE) PERMIT ISSUER (HSE)
Name: Position: Sign: Date/Time:
Name: Position: Sign: Date/Time:
□ JOB COMPLETED □ JOB CANCELLED
8. DAILY SIGNATURE (PREMIT EXTENSION)
DAY/DATE Day 1 ( date ) Day 2 ( date ) Day 3 ( date ) Day 4 ( date ) Day 5 ( date ) Day 6 ( date ) Day 7 ( date )
PERMIT APPLICANT (signature and time) (signature and time) (signature and time) (signature and time) (signature and time) (signature and time) (signature and time)
PERMIT REVIEWER (signature and time) (signature and time) (signature and time) (signature and time) (signature and time) (signature and time) (signature and time)
PERMIT ISSUER (HSE) (signature and time) (signature and time) (signature and time) (signature and time) (signature and time) (signature and time) (signature and time)
ORIGINAL : Display at the work area 2nd : Display at PTW Board 3rd: Retain in the PTW Book
