Health, Safety & Environment Plan

Electrically Energized Area Entry Permit

Form No: SECL/HSEP-28 Rev No: 00 Date: 12/09/2017

Sobha Engineering
Project:
& Contracting LLC

1. Permit Application
Permit applicant Name: Mob No :
Work Area: Drawing attached :
Applicant

Yes/No
Permit

Date: Permit Validity: (Time) No of persons working:

From: To:
Job to be done (Job description can be
detailed on a separate sheet if required):
2. Pre- Entry preparation; (To be checked by the Foreman/Supervisor/Engineer )
YES NO N/A
1 Workers are trained and competent
2 Correct work method briefed/TBT including electrical safety talk
done
3 Workers wearing adequate and appropriate PPEs
4 All tools used are insulated, inspected and proper
5 Lock out Tag out (LOTO) system implemented
6 All safety sign boards, warnings and fire extinguishers are present
7 Competent supervisor present
8 Drawing of the work area if applicable (conduit piping)
9 Cordon off the working area to prohibit unauthorized entry of
others
10 A watchman has been designated to stand by at the entrance of the
energized area.
11 Emergency and evacuation procedure established and explained to
the working team
12 All testing and measuring instruments are calibrated and approved
3. Safety Commitment:
I, being the in charge of the above work understand the hazards and taken all above precautions and
Applicant

ensuring full adherence to the same. I also undertake to continuously adhere to the intermittent
Permit

precautions, where applicable, during the course of job.

Name: Signature:

4. Permit approval by: (By SE/PE/SM)

The work is safe to carry out the hot work and handed over to the permit applicant for the above work.

Name: Signature:

5. Permit acknowledged by (Safety Officer)

Permitted/Not permitted. Comments :
(Note : Permit will be invalid if any safety precautions/control measures are not in place)

Name: Signature:

6. Permit close out request (By the permit applicant)

I have inspected the work site after the completion of work and I certify that the area is cleaned and brought to
the normal condition.

Name : Signature