ELECTRICAL 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 to the position Noise Toolbox talk is done Unauthorized access restricted
Electrocution Fall from height Suitable access and egress is provided Termination has to be made properly
Hot materials Ignition of flammables Area has to be free of liquids Electrical cabinets has 30mA circuit breaker present
Water in the working area Lack of communication Barriers and signs in place Workers to be aware of emergency procedure
Equipment not maintained Improper discharge of energies All equipment have to be checked Means of communication shall be ready
Area has to be free of flammable/combustible
Personnel uncertified / incompetent Lack of blocking materials Area shall be clean and secure
Fire Lack of cleaning of the area Only competent / certified person should be involved Electrical cabinets have been properly locked
Explosion Unauthorized access to the working area Access to work area to be restricted Placement of watchman at the door and access control
Moving machinery Other: 6. PPE
Lack if signs and barriers Safety Helmet Gloves Full body Harness
Lack of grounding Safety Boots Coverall Dust Mask
Poor lighting Safety Goggle Respiratory Protection Positive Pressure BA set
Falling object 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 (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
