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General Work Permit

This document is a general work permit that outlines the scope, location, manpower, hazards, and safety precautions for a construction project. It provides details such as the requestor's name, contractor, permit number, project title and description. Potential hazards are identified, along with required additional permits for hot work, electrical work, etc. Safety precautions like locks, tags, signs, and PPE are specified. Sections are provided for the contractor, project manager, area owner, and safety officer to verify all requirements have been met before work can begin. The permit is valid for one week and work will stop if emergency conditions arise.

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Jareem Pees
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
114 views

General Work Permit

This document is a general work permit that outlines the scope, location, manpower, hazards, and safety precautions for a construction project. It provides details such as the requestor's name, contractor, permit number, project title and description. Potential hazards are identified, along with required additional permits for hot work, electrical work, etc. Safety precautions like locks, tags, signs, and PPE are specified. Sections are provided for the contractor, project manager, area owner, and safety officer to verify all requirements have been met before work can begin. The permit is valid for one week and work will stop if emergency conditions arise.

Uploaded by

Jareem Pees
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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GENERAL WORK PERMIT

Name of Requestor: Contractor: Issuance Date/Time: Validity Permit No:


Date:

Contact No. Time:


Project Title: Scope of Work:

Location (Attach sketch if necessary) Manpower:


1.____________________ 4.____________________ 7._____________________
2.____________________ 5.____________________ 8._____________________
3.____________________ 6.____________________ 9._____________________

Project in Charge, Contractor Safety Officer and their representative shall ensure that all requirements stated herein are complied with before
the issuance of the permit.
General Work Permit is valid for 1 week only.
To be filled out by Contractor/Project in Charge

Potential hazards and Hazardous Jobs


 Potential oxygen deficiency or enrichment  Introduction of ignition sources
 Potential flammable/explosive atmosphere  Electrical troubleshooting or repair on live circuits
 Potential high temperature/pressure  Exposure to road traffic
 Potential exposure to hazardous chemicals  Temporary or permanent changes, alterations,
(Toxic, reactive, acid, caustic….) modifications of equipment or processes
 Exposure to moving/rotating machinery  Maintenance or repairs in areas, or to equipment or
 Bypassing or removing/altering safety lines, containing or supposed to contain hazardous
devices and equipment materials or conditions
 Use of mobile crane, back hoe and
other heavy equipment

Additional Special Permit for the activities listed below:

 Hot Work  Electrical Work  Chemical Handling Work


 High Place Work  Confined Space Work  Mechanical Work

Safety Precautions

 Safety locks and tags (Mechanical and Electrical)  Safety warning signs  Depressurization
 Fire extinguishers  Proper ventilation  Clear area of combustibles
 Fire watcher  Operator’s certificate  Wet surrounding area
 Electrical isolation/barricading  Standard illumination  Eliminate ignition sources
 Audible/visible warnings  Gas/Oxygen test  Safe Work Load of equipment
________________________

Personal Protective Equipment

 Head : _____________________  Feet : _____________________


 Face : _____________________  Body: _____________________
 Eyes : _____________________  Breathing: _____________________
 Ears: _____________________  Others: _____________________
 Hands: _____________________ _____________________
To be filled by TMP Safety Officer

 Work area has been identified to concerned workers and that the proper area separation/barricade/enclosure installed.
 Total Weight of Load to be lifted: _________ is within Safe Work Load of Equipment: __________
 Potential safety and health hazards related to the work have been assessed (Job Hazard Analysis).
 Concerned workers undergo and passed the SAFETY AND HEALTH Orientation.
 Contractors conducts toolbox meeting before the execution of activities with minutes.
 Proper and in good condition hand and power tools has been provided to worker.
 Proper Waste Segregation and Disposal has been met.
 Proper Personal Protective Equipment has been determined.
 Provision of Project Management Board which includes the following:
DENWANCHO, Organizational Chart, Schedule of Activities, Project and Emergency Evacuation Layout, House Rules and
General NAIKI, Safety Calendar, Anzen Leader Board, Work Permit.

Contractor: Project in Charge and Section Manager:

I certify that the above have been completely filled I certify that the above have been adequately
out with pertinent details of the project work scope for the verified and complied with. Hence, work permit is
authorization of the work permit. authorized and being requested for approval.

Signature over Printed Name Date Signature over Printed Name Date

Area Owner/Affected Section: TMP Safety Officer

I hereby acknowledge the work to be done has I certify that all safety requirements needed by
been clearly communicated to all concerned personnel. TMP Safety Audit Group have been met and all safety
controls has been complied by contractor.

Signature over Printed Name Date Signature over Printed Name Date

Important Notes:

In the event of an EMERGENCY or there are changes in the work area conditions making it unsafe to
continue work.
A. The permit is automatically cancelled.
B. All works must be stopped immediately.

Work can ONLY be resumed upon clearance from TMP Safety Officer.
Contractor shall submit the following attachment such as applicable drawing and JOB HAZARD ANALYSIS prior to
work and must be noted by TMP Safety Officer.
NO SAFETY OFFICER NO WORK POLICY

KEEP THIS WORK PERMIT POSTED AT WORK AREA FOR INSPECTION

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