Professional Documents
Culture Documents
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Donde se usa un Permiso
de Trabajo?
TRABAJOS RIESGOSOS
16
Permiso de Trabajo -
Documentos
……………………………..…..……..……………………..…… Use the back of the permit to add other necessary precautions
I certify that I am aware of my responsibilities and have I certify that I have fully considered the implications of the work in line
read, understood, and will establish and maintain the with the responsibilities given overleaf and confirm that I am authorized to
precautions detailed above. I shall ensure that all persons issue this Permit To Work and that the above precautions are adequate for
under my control are also aware of the safety the work to be carried out provided they are established and maintained.
requirements and responsibilities. Signed ASI Date
Signed Permit Applicant Date
……………………………..…..……..……………………………………….
………………………………….……………...………… From To
Date Time Date Time Sign Date
Permit Validity: The work may be undertaken between the
times specified here, extensions beyond this time must
be re-authorized.
Hand back
I certify that the work has been completed* and the site left in a safe condition. (*If not completed, describe reason)
Signed Permit Applicant Date Accepted by ASI Date
.....................
……………………………..…..……..………………. .....................
……………………………..…..……..……………….
Certifies that equipment to be worked on has been isolated and that measures have been taken to
prevent reconnection. For scope refer to the PtW Guideline.
arranque
switching OFF the (Miniature) Circuit Breaker(s)
inadvertido
is also displayed at the above ticked location is also displayed at the above ticked location
Signature:…………………………………………….. Signature:……………………………………………..
Date:…………...…………………………………….. Date:…………...……………………………………..
Certifies that all activities at height (defined as above 1.50 m.) are carried out taking into considerations
all precautions to avoid fallings
Andamios
Others Keep areas clear around top and bottom
Life jackets (if working above water) needs JHA
Proceso de entrega
Other Precautions to be taken
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
Escaleras …………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
I have checked the working area and certify that the activities proposed under Permit to Work Number ..............
Instalación dated ………… can be carried out in a safely manner.
Signature:……………………………………………..
Condición
Situation Sketch / Indication of Hazards
Acceso
Cinturón de Seguridad
Notes
Precauciones a Not for suspended scaffolding, for this type a JHA will be required
Wood and aluminum scaffolds are forbidden. (fire vulnerability). Working at Zone 1 requires PTW
If the total length of the climb on a fixed ladder equals or exceeds 7.30m, the ladder must be equipped with ladder safety devices
or self retracting lifelines and rest platforms at intervals not to exceed 45.70m.
considerar
Ing. Jaime Oscar Gonzalez EHS Consulting Group
24 - 3
Andamios y Escaleras
To be used for work involving actual or potential sources of ignition, including welding, flame cutting,
spark-producing tools, non-intrinsically safe tools.
seguridad
Fire extinguishers placed for easy use
Espacios confinados
Required gas test frequency: every ………….. hours* / once only*
*delete as appropriate
Extinguidores
GAS TEST - Initial Result Yes / No Date Time
Gas test taken and found satisfactory ……………… ………………
(not more than 1% LEL)
Peligros
Gas test meter used: Make: ………………….
Model: ………………… Signature:……………………………………………..
Date last tested / calibrated: ………………… Gas Tester
Date
Time
Gas Meter Reading
Checked by (initials)
Date
Time
Gas Meter Reading
Checked by (initials)
para construcción,
desmantelamiento y Soldadura, uso de llama
limpieza que no o arco eléctrico.
producen chispa. Equipo que puede
Perforación, golpear y producir calor, llama o
cortar donde las chispa
herramientas y el trabajo Picar, perforar,
se mantienen debajo de remachar, chorro de
los 100 grados arena, etc...
centígrados.
Certifies that the atmosphere is safe for breathing and that breathing apparatus is not necessary. If
apparatus is necessary, a specific JHA must be done and this one must be signed by a HSSE advisor who
is certificated as ASI too.
Emergency telephones numbers must be available at all times.
Fill the checklist provided in the PtW System Guideline before commencing (part if this spreadsheet)
Gas test The space was personally tested by me for the gases below with the following results:
Gas name
……………………… ……………………………………
Test method/ equipment Concentration found*
………………………….. ………….
units
………..
OEL
……………..
units
GAS TESTS - Subsequent Checks Required gas test frequency: every ………….. hours* / once only*
*delete as appropriate
Oxygen Flammability
20<%vol<21 <1% LEL
Date Time Reading Reading Reading Reading Reading Reading Name Sign
1
2
3
4
5
regularmente
durante el trabajo y
después de cada
interrupción
Ing. Jaime Oscar Gonzalez EHS Consulting Group
34 - 3
LA UNION HACE LA
FUERZA?
Certifies that plann ed activities are managed in order to avoid accidents in any public roads, streets and
similar areas w here the ri sk of high speed traffic exists or where the n umber of vehicles circulating is high
velocidad o
the limits of the high way right-of-way, and shall protect the public until all permit associated works are complete
- For jacked installations acro ss and beneath any freeway, no vehicle, equipment nor material shall be any nearer to any freeway travel lane
than the jacking pits; and no jacking pit shall be any nearer to the outer edge of the nearest freeway lane than 9 meters
circulación de tráfico
- W arning signs are located as f ar as necessar y to avoid vehicles obstruction
- Signs are sufficient and in good conditions and are clearly visible or, must comply with the Traffic Control standards as per local regulation
- "Flaggers" are using reflective vests and flags are in good condition
- Avoid the entrance of any third party to the working area
vehicular
- No vehicle, equipmen t or material relating to the permitted work shall be parked or stored within the limits of the high way right of way
except such as are actively engaged in the work operation.
- Notify the neighborhood about the acti vities to be carried and the duration
- W orkplace m ust be in the same conditions before the activities were done. Do not let unfinished works
……………… ……… …….. …..………… ……… ……… ….……..……… ……… ……… ……… ……… ………… ……… ……… ……… ………… ….
Instrucciones I have checked the site and sur roundings an d certify that the propo sed activ ities und er Permit to W ork number ………..
dated ……… … can be carried out:
Precauciones
a)* without
with therisk
helpofofdam
Muni
age
cipal
to any
authorities
underground
to control
servtraffic
ices
b)* By doing a a JHA to implement additional preca utions. Details are ex plained in M ethod of st atement
adicionales
…………………………… …………………………… ………………………… …………………………… ………………
…………………………… …………………………… ………………………… …………………………… ………………
…………………………… …………………………… ………………………… …………………………… ………………
…………………………… …………………………… ………………………… …………………………… ………………
…………………………… …………………………… ………………………… …………………………… ………………
Certifies that planned excavation will not damage existing buried facilities such as pipelines, drains
and electric cables.
A Clearance Certificate or equivalent is required for any excavation work. For any excavation work where there is risk of
damage to buried pipework, equipment, structures foundations, electric cables or harm to personnel, the Clearance
Certificate should be supported by an Excavation Certificate.
Certificado de área - piping and electrical / instrumentation cabling must be localized by hand digging (with spades)
- identified cabling and piping must be marked with wooden pegs
- piping and cabling may have moved from its original location, as indicated on as-built drawings, due to soil settlement
- within 1 meter radius around piping and cabling, only hand digging with spades may be used
despejada
- excavations deeper than 1.2 meters require slopes of 70 degrees (max) or side supporting structures to prevent collapse
- use of digging machinery is allowed: yes / no (a Gas Test Certificate - Hot Work might be required)
- exposed piping and cabling to be supported
- the handling of contaminated soil requires the use of PPE as defined on the Permit To Work
- debris to be at least …….. meters from the edge of the excavation
Exact location……...…….……………………………….…………...………………………………………………............
infraestructura
……………………………..…..…………………………….……..……………………………………………………………………………………….
I have checked the site / studied the layout drawings and certify that the excavation proposed under Permit to
Work number ……….. dated ………… can be carried out:
Instrucciones para
a)* without risk of damage to any underground services
b)* provided that the following additional precautions are taken to prevent damage to the equipment/services
specified below:
…………………………………………………………………………………………………………………………………
la excavación …………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
adicionales
Situation Sketch / Indication of Hazards
Esquema