PERMIT TO WORK

VEHICLE MAINTENANCE PERMIT

Project Name: Permit No. Date:
Spine Grading Earth Work Project
1. Name of Contractor:
2. Location
3. Description of work:

4. Vehicle / Equipment Number:

5. Precautions Required:
Concrete Flooring.
Bond Wall of Concrete Floor/ Dip Tray. (1.5m W, 1.5m L, 0.3 m H)
Spill Kits (Full size)
The site free of litter
All waste on site containerized at all times.
Are bins/waste containers suitable for the types of waste being generated at work shop
locations?
Are all bins clearly labelled, with lids that remain closed?
Overfilling of bins/waste containers prevented?
Is a dedicated central waste storage location (CWSL) provided for the site?
The dedicated CWSL clearly identified with suitable signage?
There a sufficient number of skips provided at the CWSL?
Waste at the CWSL stored in skips and prevented from being stored not on the ground?
Waste segregated into the Correct dedicated Skips/containers at the CWSL?
Skips/containers which contain light-weight material covered with a net?
Overfilling of skips/containers prevented?
Is a HAZWASTE Storage Facility (HWSF) provided?
Is general waste bins/skips/containers free of chemical/contaminated/hazardous waste?
Are all liquid hazardous waste containers provided with secondary containment/spill trays?
Is Vehicle / Equipment on site in a good state of repair and suitable for the tasks?
Are spill trays clean & free of litter/sediment?
Are all vehicles and equipment free of hydrocarbon leaks?
Are hydraulic hoses free of damage/excessive wear and tear?
Is maintenance conducted in a bunded maintenance workshop with impervious flooring?
Details of emergency spill response teams displayed
Spill warning signs/awareness material displayed at all Location of work shop
Proper House keeping Staff for Work shop Area.

Personnel Protective Equipment:

6. Permit Validity (24 Hours)

From: Date: / / Time: Until: Date: / / Time:

7.Issuing Authority:

Authority Person Name: Signature:

Title: Date/Time:
 PERMIT TO WORK

VEHICLE MAINTENANCE PERMIT

8.Performing Authority:
I have read and fully understood the conditions of this Permit. These will also be fully explained to the
persons who will carry out the work.
Recipient Name: Signature:

Title: Date/Time:

9. Cancellation:
I have completed the work stated in Section 3 (above) and work location is now in a safe condition.

Performing Authority (Print Name): Signature:

Title: Date/Time:

I have accepted that the entry and work has been safely completed.
Area Authority: Signature:

Title: Date/Time: