SEGNOR Construction & Development Corporation

#152 Mary St. Villa Angelina Subd., Angeles City

Office No: (045) 322-8660 | Email: segnorconstruction99@gmail.com

STRIPPING WORK PERMIT

Project Name: Date and Time:
Contractor: Reference Number:
Specific Area / Location of Work:

Item Name of Workers Signature

1
2
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10
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Requested by: Checked By: Approved by:

____________________________ ________________________________ _______________________

Subcontractor EHS Officer (SCDC) EHS Manager (SCDC)
(Signature over Printed Name)
REMARKS: Conformed by:

Workers wearing complete PPE

____________________________
Project Manager / OIC (Subcontractor)
Workers wearing incomplete PPE
Noted by:
JHA Complied

JHA Not Complied

____________________________
Project Manager (General Contractor)