PERMIT TO WORK

BLASTING WORKS
Project Name : …………………………………………
Permit No : ………………………………………….

A. Applicant Detail
1. Name of Sub-Contractor ……………………………………………………………. 1. Blasting Consultant: ………………………………………….…………… Supervisor In Charge : …………………………………………………
2. Tel No : …………………………………………………………………………………
3. Person In Charge/Competent Person :…………………………………………… 2. Tel No: ……………………………………………………………………... Tel No : ……………………………………………………………………
4. Location of blasting : ……………………………………………………………….
5. Duration of Work: …………………………to …………………………………….. Signature : ……………………………………………………………….
Type of explosives & detonators
1 1. Shot Firer: ……………………………………………………… Date : ……………………………………………………………………...
2
3 2. Tel No. : ………………………………………………………… Location/ Zone : ………………………………………………………...
4
5 Signature : ………………………………………………………… …………………………………………………………
6
Signature : ………………………………… Date : ………………………………………………………………
Date : ………………………………….
B Pre-entry Checklist
Pre-entry checklist Yes No Remarks
Permit/approval (for blasting works) from Police/Authority Permit No. & Date:
Permit/approval from Police/Authority I have checked both the job and the permit. I understand the nature and extent of the Work and the
Permit No. & Date:
(for buying, carrying & using the explosive materials) precautions and procedure to be followed in completing the work safely:
SWI Issued Issuance Date: Description Name Date Time Signature
SWI briefed to all workers Briefing Date: Checked By: (Work Supervisor)
Checked & Verified By: (Safety
SOP (attachment) issued Issuance Date:
Personnel)
SOP followed Verification Date:

C Approval and Authorization (By Authorized Personnel)

I hereby approve the work operation to be executed accordingly.

Signature: ………………… ……………………. Name: ………………………………………… ……… Position : ………………………………………………….. Date: ………………………………………..
D Validity of Permit
This permit is valid for max seven (7) working days, ( Daily PTW need to apply for Critical works)
Renewal (if applicable)
Date Time valid until Authorized Signature Checked By (Work Supervisor) Date Checked By (Safety Personnel) Date Remarks
1
2
3
4
5
6
7

Doc. Ref. : PCD/OSH/SF/34 Rev. No. : 4 Effec. Date: 01 April 2019 Page 1 of 1