Permit to Work Template
Author: Novade Solutions
Permit to Work Template
General Work Permit
Work Location Photo
Please check the following items. Select Yes - To indicate OK; No - To indicate not OK ; N/A - To indicate against conditions that are not required
1. Workers briefed on risk assessment. Safe work procedures, and adequately trained according to Method Statement.
2. All electrical hand tool /equipment used have been inspected. certified and labeled by a Licensed Electrical Worker.
3. Ladder used have been checked by a competent person on a monthly basis and the ‘Safe for Use’ tag is attached to the ladder.
4. All dangerous parts of equipment and tools used are securely guarded.
5. Provision of signage and barricade at work area.
6. Good housekeeping maintained on site.
7. Adequate lighting provided (including emergency lighting).
8. No incompatible works at surroundings.
9. Workers equipped with proper PPEs.
Photos/Attachment [if any]
Applicant Signature
Approvals
Endorser Signature
Approver Signature
Rejection / Cancellation [if any]
Download PDF
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Permit to Work Template
General Work Permit
Work Location Photo
Please check the following items. Select Yes - To indicate OK; No - To indicate not OK ; N/A - To indicate against conditions that are not required
1. Workers briefed on risk assessment. Safe work procedures, and adequately trained according to Method Statement.
2. All electrical hand tool /equipment used have been inspected. certified and labeled by a Licensed Electrical Worker.
3. Ladder used have been checked by a competent person on a monthly basis and the ‘Safe for Use’ tag is attached to the ladder.
4. All dangerous parts of equipment and tools used are securely guarded.
5. Provision of signage and barricade at work area.
6. Good housekeeping maintained on site.
7. Adequate lighting provided (including emergency lighting).
8. No incompatible works at surroundings.
9. Workers equipped with proper PPEs.
Photos/Attachment [if any]
Applicant Signature
Approvals
Endorser Signature
Approver Signature