IBTHAJ MUSCAT TRADING & CONTRACTING CO LLC
PERMIT TO WORK SYSTEM - GENERAL WORK PERMIT
Contractor:
Project Name: Location :
Expected
Starting From Date Time Date Time
Completion
Work Description
Tools & Equipment used:
Identify the Nature of Work
Excavation Cable laying Working with Hand Tools and Power tools
Preparing cable drum jacks, rollers etc. Civil Work Back filling and compaction work
Lifting operation Mini feeder pillar installation Working at heights
Heavy equipment operation Termination / joints of cable Earth pit construction
The following document must be attached with this permit
HSE PLAN QUALITY PLAN RISK ASSESSMENT METHOD STATEMENT
Precaution require to complete the work safely Yes No N/A
Workers have all the required PPE’s.
Are relevant safety signboards or signals displayed at the work site?
Is there any energized electrical component in close vicinity of work area?
Is adequate welfare facilities (rest shelter, drinking water and first aid kit) are available at site?
Hand tools and power tools have been inspected and color coded for the month?
Is tool box talks conducted and all the safety precaution been communicated to workers?
Are relevant risk assessments and method of statements available at site?
Are the supervisor or site engineer available for close monitoring during the job?
Other relevant permits issued?
Other (specify):
The following areas / items have been inspected by issuer and receiver
Fire Extinguisher Type...................... Quantity................ Size....................
Emergency numbers displayed Danger/Warning Sign Fire warden available Safety Barriers
Qualified First Aider available Drinking water available Rest shelter for workers All the power tools and hand tools inspected
Fire Blanket Housekeeping conditions Other (specify)
PPE Required for the activity
Helmet Safety Shoes Gloves
Goggles Safety Vest Ear Plugs/muff
Full Body Harness Mask Others (specify):
Issue and acceptance before work
Acceptance of Work Permission by the person in-charge (Receiver)
I certify that, I have read and verified this work permit and checklist. I have been informed about the risk assessment results. I am aware of the risks that can be
exposed to. I commit that I will be in line with all safety rules mentioned in work permit checklist and will not deflect any of them.
Name: Signature:
Authority to proceed by authorized person (Issuer)
I reviewed the work permission checklist and checked the working conditions. I have reviewed the all aspects of the task/activity and am satisfied with the
arrangements as detailed in the “risk assessment” have been put in place and certify that the activity detailed above is authorized to proceed
Name: Signature:
Acknowledge to Safety Engineer/Officer
Name : Signature:
Clearance and cancellation after work 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 / not complete.
Name: Signature:
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:
