WORK PERMIT

HSE-WP-001
Project Name : ______________________________ Name of Subcontractor/Company: __________________________
P.O No. / Job Order No. _______________________
Pre Project Mobilization Requirements
Construction Safety &
Contractor's All Risk Insurance (CARI) Rule 1020-DOLE Registration
Health
Red Program
Cross Certificate/I.D for COSH Certificate for Safety
PCAB License
First Aider Officer
Method Statement Hazard Identification Risk Assesment and Determine Control (HIRADC)
Remarks:_____________________________________________
Note: Failed to submit mobilization requirements
Descrption of works (list all task involve in the work)

No. List of assigned employees List of materials/tools/equipment/PPE needed

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Notice To Proceed (NTP) Requirements Checklist
Construction Safety &
Contractor's All Risk Insurance (CARI) Rule 1020-DOLE Registration
Health Program
Red Cross Certificate/I.D for COSH Certificate for Safety
PCAB License
First Aider Officer
Method Statement Hazard Identification Risk Assesment and Determine Control (HIRADC)
Remarks:_____________________________________________
CONTROL PERMIT NO: _____________________________ LEVEL/AREA OF WORK: _________________ Date of Mobilization: ________________________
REQUESTED BY: CHECKED BY: APPROVE/NOTED BY:

_______________________________________ _______________________________ __________________________________

Subcontractor Owner/Representative TECI - HSE Dept. TECI - Operation Manager
PERMIT CLOSE OUT
PERMIT CLOSE OUT - SUBCONTRACTOR ( PERMIT RECEIVER )
The subcontractor acknowledge that the activity/scope of work has been completed and subject

Name: _________________________________________ Signature: ______________________________ Time: _______________ Date: ________________

PERMIT CLOSE OUT - TECI ( PERMIT ISSUER )
The permit issuer acknowledge that the activity/scope of work has been completed
Name: _________________________________________ Signature: ______________________________ Time: _______________ Date: ________________