Project No.

IDWAG

Subject

PERMIT TO WORK FOR LV ELECTRICAL

ROOM
Main Contractor: Urbacon Trading & Contracting

PTW-Electrical

REV 00
OCT 2015

Date
PERMIT TO WORK NO.

Project Name & Location: Interior Design Works of Amiri

Guard, Doha

DISTRIBUTION (NAME PLUS DISCIPLINE OR COMPANY)

Electrical Room No:

Work Description:

From:

Location:

To:

Drawing No:

1. Authorization for Work: This Permit is issued for the following work:
________________________________________________________________________________________________________________
2. Danger and caution notices are to be posted at:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
___________________________________________________________________________________________________________
4. NAMES OF WORKERS
NAME

COMPANY

TIME
IN

SIGNED

TIME
OUT

SIGNED

Authorized Representatives:
NAME

TITLE
Prepared by:

Person In Charge

Checked by:

HSE Officer

Approved by:

Electrical Engr.

Time Work Start:

Remarks:

SIGNATURE

DATE

Time Work Finished:

Remarks:

Sign Off:
I hereby confirm that the Electrical work area is inspected after 1 hour of work completion for potential Electrical hazard and found safe.

Person In Charge: _______________________ Signed_____________________Date:_____________

NAME

TITLE
Checked by:

HSE Officer

Approved by:

Electrical Engr.

SIGNATURE

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Project Manager

Supervisor

Operatives

SAFETY

DATE