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Cold Work Permit

The Cold Work Permit document outlines the necessary information and requirements for conducting cold work activities, including details about the project, risks involved, and safety measures. It includes sections for identifying hazards, required personal protective equipment (PPE), and the acceptance of work by both the issuer and receiver. The document also provides a framework for clearance and suspension of the permit after work completion or if safety concerns arise.

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mengo
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83 views1 page

Cold Work Permit

The Cold Work Permit document outlines the necessary information and requirements for conducting cold work activities, including details about the project, risks involved, and safety measures. It includes sections for identifying hazards, required personal protective equipment (PPE), and the acceptance of work by both the issuer and receiver. The document also provides a framework for clearance and suspension of the permit after work completion or if safety concerns arise.

Uploaded by

mengo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

COLD WORK PERMIT

PTW Ref. No. Contractor(s)


Project Name: No. of employees Inv.
Starting from: Date Time Expected Completion Date Time
Activity:
Work Description:
Location to be performed:
Tools/Equipment to be used:
Identify Risk associated with this COLD WORK
Fall from height Adverse Weather Flying Objects Noise
Falling Protruding Tripping, Slipping Faulty
debris/Objects Objects/Parts tool/Material
Noise Heat Vibration Poor
Illumination
Other (Specify):
The following document must be attached with this permit
Method Statement Risk Assessment Other (Specify):
Precaution measures require to complete the work safety YES NO N/A
Have tools and devices to be used been tested and adjusted?
Have all hazards/hazardous related to this activity identified and assessed?
Working at Height Scaffolding Pressure Test Chemical
Electrical Saw/Cold Cut Hot Surface Tool/Equipment
Dust Lifting
Are permit associated require for this activity? If yes, mentioned below;
Hot Work WAH Excavation Electrical Confined Space
Other (Specify):

The following areas/item have been inspected by issuer and receiver.


Access/Egress Danger/Warning Lighting Safety Barriers
Sign
Hand tools Other (Specify):
PPE Required for the activity
Hard Hat Safety Shoes Safety gloves Safety Ear
plugs/Muffs
Safety goggles Reflective vest Dust mask Safety clothes
Other (Specify):
Issue and Acceptance of work
Acceptance of work permission by the person in-charge (Receiver)
I certify, I have read and verified this work permit and checklist. I am aware of the risk that can be exposed to. I
commit that will be with all safety rules mentioned in work permit checklist and will not deflect any of them.

Permit Receiver Name: Signature/Date:


Authority to proceed by authorized person (Issuer)
I reviewed the work permission checklist and checked working conditions. I have reviewed all aspects of the
task/activity and satisfied with the arrangements as detailed in the “Risk Assessment” have been put in place and
certify that the activity detailed above authorized to proceed.

Permit Issuer Name: Signature/Date:


Acknowledge by Contractor’s Safety Engineer/Officer

Name: Signature/Date:
Clearance and cancellation after work and or Suspension of Permit
Clearance. (Site Manager)
All men, materials, tools equipment, housekeeping etc. under my charge have been withdrawn. The permitted work is
complete/Incomplete

Name: Signature/Date:
Suspension
This permit is suspended, I have notified the authorized person specified that the work is not complete the
area/equipment is not safe to use.

Name: Signature/Date:

ODI-PERMIT SYSTEM

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