Attachment 8.3.3 - Permit To Work Form Rev003 Updated

관리번호
협력업체 공사담당자 공사팀장

작업허가서(PTW)
업체명 : 작성일 :
공구명 : 허가기간 :
작업장소 : 작성자 :
장비 현황 기계기구 현황
허가작업 작업내용 작업팀장
장비명 규격 대수 기기명 대수
9개작업중
선택!!
작업인원
보호구
작업시 요구사항
작업 위험성 평가
평가등급
작업내용 위험요인 발생 위험 평가 위험 저감 대책
빈도 강도 등급
공사팀
추가
코멘트
HSE팀
평가등급 : A(허용불가-심각), B(중대), C(보통), D(허용가능), E(작다) HSE 팀장 일시 : (서명)
월 일 월 일 월 일 월 일 월 일 월 일 월 일
확인일시
시 분 시 분 시 분 시 분 시 분 시 분 시 분
확인자
작업상황도
작업허가서
업체명
관리번호
작업내용
※ 밀폐공간 작업시 해당 : 작업자 성명 및 휴대폰 번호를 기재바랍니다.

작업자 성명
및 연락처
작업상황에 대한 안전조치 사항을 그림 또는 도면, 글씨로 표현
작성자 성명 서 명
TIP
1. 대상작업 (9개 위험작업)
- 고소작업 : 높이 1.8m 이상 고소작업
- 비계작업 : 비계 사용(설치, 해체 포함) 및 틀비계 사용작업
- 거푸집작업 : 갱폼 및 강재거푸집 설치, 해체, 탈형 및 인양작업
- 굴착작업 : 굴착깊이 1m 이상 작업
- 장비작업 : 1톤 이상 중량물 인양 및 하역 작업, 로울러 장비사용 작업
- 고소작업대 : Sky, 곤도라 작업, 로프이용 말비계작업(외부 도장 등)
- 화기작업 : 용접, 용단, 그라인딩, 금속재 절단 등 불티발생작업
- 사다리 사용작업 : 이동식 사다리, A형 사다리 등 사용작업
- 밀폐공간 작업 : 산소결핍 우려 장소 작업(맨홀, 정수조, 탱크내부 등)
2. PTW 업무 flow chart
3. 사용방법
- 작업허가서는 노란색 테두리, 작업상황도는 파란색 테두리 사용하고
1회 출력만 가능하도록 함. (HSE팀은 반복 출력 가능)
- 작업내용 입력란 및 위험성 평가 입력란에 따라 장수 늘어날 수 있음
- 작업상황도는 허가서와 연계하여 발행 : 그림, 도면, 글씨로 표현은 출력후 작성
- 9개 허가작업중 1개만 선택할 수 있음(즉, 각각의 위험작업에 대해 개별 신청하여야 함)
- 위험성평가 빈도, 강도, 등급은 팝업창 추가 및 등급 자동계산
4. 기타사항
- 대상 작업 시작 1일전 신청 (예외 : 익일 중량물 취급작업으로 일대 장비 투입시 작업전일까지)
- PTW 재신청 기준 : 사용 건설장비 교체 및 증가시, 작업내용 변경시,
작업기간 연장시(승인 작업기간은 7일 기준), 작업인원 증가시(밀폐공간만 해당)

서명지 추가 안함 : 기존 OFF-LINE TBM 양식 사용함.
PTW (Permit To Work) LOG SHEET
결재진행상태
허가서
NO. 협력업체명 공구명 작업장소 허가작업 작성자 작성일 종료일 비고
관리번호
공사담당 공사부장 HSE 팀장
HOT WORK PERMIT Firewatcher present
Firewatch extinguisher
Containers for welding rods to be provided
Work area kept wet
System Electrically Isolated
System Mechanically Isolated
Erect signs and barriers Keep work site free of trip hazards Adhere to lifting plan/method statement
Compnay Name:- ______________________
Permit Registry No.
JSA Comply with MSDS Equipment to be isolated when left unattended
THIS PERMIT IS AUTOMATICALLY SUSPENDED UPON ACTUATION OF THE GENERAL ALARM
Control the working hours Measure the temperature Water station
AND MUST BE RETURNED TO THE PTW OFFICE FOR RE-ISSUE BEFORE RESTARTING WORK
Others :
1. SPECIFICATION OF WORK
5. PERSONAL(PERSONNEL) PROTECTIVE EQUIPMENT & SAFETY EQUIPMENT REQUIRED
Work Location : System (Item NO.) :
Eye protection Face shield Full chemical suit Fire Blanket Safety harness Eye Wash Station
Work Description : Welding Cutting Grinding Hot Tapping Others
Hearing protection Dust mask Paper Coveralls Inertial reels Work lifevest Radio
Head protection Foot protection Fire Extinguisher Life Line Escape (BA) Set Rubber Boots
Equipment & Tools to be used :
Rigger Gloves Personnel Gas Detector Industrial Gloves Welding shield Tripod OSR Equipment
Validity : This Permit is valid from DATE Hrs to DATE Hrs
Cold Weather Clothing Ice and Snow Traction Fire Retardant Clothing Emergency Shower Fresh air mask Full/hair face gas mask
Requested by : Signed : ※ Task must be clearly described.
Gas Detection : O2 CH4 H2S CO Other :
2. SAFETY CHECK
Others :
YES NO NA* YES NO NA*
6. GAS ANALYSES OR INITIAL GAS TEST(Authorized Gas Tester)
A. Equipment Preparation C. Adjacent work site precautions
1 Has been thoroughly depressurized 1 Is notification given to safety about Details Date Authorized Gas Tester
2 Has been thoroughly drained possible road blocks 8 hourly Time Name
3 Has been isolated by 2 Has wind direction been considered 4 hourly Combustible (%) Initials
- Blinds 3 Is hazards from adjacent work taken into Continuous Toxic/H2S Date
- Disconnecting consideration Other : Oxygen (%) Time
- Double block and bleed valves 4 Is there any radio active hazard ※ Initialled by Authorized Gas Tester as being within acceptable gas test limits. ※ Usable O2 CH4 H2S
4 Has been water flushed D. Prime mover isolation ※ Comments/Remarks : other sheet CO Other
5 Has been purged with inert gas/steam 1 Has been isolated from mechanical motive
7. APPROVAL & ISSUE
6 Has been ventilated power and steam valves locked off
B. Site preparations/ precautions 2 Has been isolated from other power sources Step1. Prepared by ( Subcontractor Engineer )
1 Is the site cleared of combustible materials 3 Has been electrically isolated and tagged Date : Time : Name : Signed :
2 Is adequate fire-fighting equipment located 4 Has power source been disconnected Comments :
at the work site Isolation slip No. Step2. Reviewed by ( HEC-HSE Authorized Representative )
3 Is the fire guard on the site Date : Time : Name : Signed :
4 Should work site be kept cooled/flooded E. Is the Excavation Approval form enclosed? Comments :
with water Excavation Permit No.
5 Are adequate gas analysis performed Step3. Approved by ( HOD Construction Authorized Representative )
6 Should gas analysis be repeated F. Moving Heavy Equipment Date : Time : Name : Signed :
7 Should portable explosive meter with Is the approval form for Heavy Loads on Comments :
Alarm be used ground Enclosed? Step4. Accepted by (Subcontractor Task Supervisor / Site Manager)
8 Is cordoning of area done
I have read and understand the above conditions and precautions and declare that I accept responsibility for
9 Is warning sign put NA * - Not Applicable carrying out work specified on this Permit, that no attempt will be made by myself or by the persons under my control to
3. HAZARDS IDENTIFIED carry out any other work, and that I will notify the Contractor engineer(HEC) upon completion/suspension of this work.
Extreme weather Flammable materials Explosives Noise High Voltage Date : Time : Name : Signed :
Confined space Electrical Spark Danger of falling Tripping/Slipping Hazard Low Voltage 8. RE-VALIDATION ( Compulsory RE-VALIDATION of the work permit each shift - to Continue work )
Awkward Access/Egress Welding sparks Vehichle Traffic Hot materials Manual handling Subcontractor HEC HEC - HSE Subcontractor HEC HEC - HSE
Date Validity Time Date Validity Time
(Task Supervisor) Site in-charge (Coordinator) (Task Supervisor) Site in-charge (Coordinator)
Toxic gases/fumes Eqpmt causing sparks Lifting operation Working at Height Severe/Adverse Weather
Signature Signature Signature Signature Signature Signature
Limited/poor lighting Moving machinery Pintch points Live Equipment Sharp edges Signature Signature Signature Signature Signature Signature
Radioactive Source Vibration Excavation Collapse Pressurized Hose Failure Unguarded Opening
Lines/hoses under pressure Hazardous Substances Underground Utility Overhead Power Line Dropped Object Signature Signature Signature Signature Signature Signature
Others :
9. PERMIT CLOSE-OUT ( CLOSURE )
4. PRECAUTION TO BE TAKEN
Closed by(Subcontractor) Accepted by (HEC-HOD) Registered by (Permit Coordinator/HEC-HSE)
Thoroughly ventilated Fire hose run out and pressurised Provided with suitable access and egress
Date Time Date Time Date Time
Gas test required Fire resistance blanket/habitat erected Area free of flammable/combustible materials Signed Signed Signed
Maintain radio contact Depressurised Earthed for static

Cross-Referenced Documents : YES NO
Water flushed Secure loose objects Drained free of liquids ※ NOTE
Attached File : YES NO
COLD WORK PERMIT Fire watch extinguisher
Erect signs and barriers
Work area kept wet
Keep work site free of trip hazards
Adhere to lifting plan/method statement
Compnay Name:- ______________________
Permit Registry No.
Others :
Hearing protection Dust mask Paper Coveralls Inertial reels Work life vest Radio
Work Description : TESTING ISOLATION MARINE WORK DIVING WORK SCAFFOLDING
FLOORING AND GRATING REMOVAL WORKING AT HEIGHT MAN-BASKET OPERATION
OTHER

Others :
Not Required Date Authorized Gas Tester
2. SAFETY CHECK
8 hourly Time Name
YES NO NA* YES NO NA* 4 hourly Combustible (%) Initials
A. Equipment Preparation 3 Is hazards from adjacent work taken into Continuous Toxic/H2S Date
1 Has been thoroughly depressurized consideration Other : Oxygen (%) Time
2 Has been thoroughly drained 4 Is there any radio active hazard ※ Initialled by Authorized Gas Tester as being within acceptable gas test limits. ※ Usable O2 CH4 H2S
3 Has been isolated by D. Prime mover isolation ※ Comments/Remarks : other sheet CO Other
- Blinds 1 Has been isolated from mechanical motive
7. APPROVAL & ISSUE
- Disconnecting power and steam valves locked off
- Double block and bleed valves 2 Has been isolated from other power sources Step1. Prepared by ( Subcontractor Engineer )
4 Has been water flushed 3 Has been electrically isolated and tagged Date : Time : Name : Signed :
5 Has been purged with inert gas/steam 4 Has power source been disconnected Comments :
6 Has been ventilated Isolation slip No. Step2. Reviewed by ( HEC-HSE Authorized representative )
B. Site preparations/ precautions Date : Time : Name : Signed :
1 Is gas analysis performed E. Is the Excavation Approval form enclosed? Comments :
2 Should gas analysis be repeated Excavation Permit No.
C. Adjacent work site precautions Step3. Approved by (HOD Construction Authorized representative )
1 Is notification given to safety about F. Moving Heavy Equipment Date : Time : Name : Signed :
possible road blocks Is the approval form for Heavy Loads on Comments :
2 Has wind direction been considered ground Enclosed? Step4. Accepted by (Subcontractor Task Supervisor / Site Manager)
3 Is hazards from adjacent work taken into
consideration NA * - Not Applicable carrying out work specified on this Permit, that no attempt will be made by myself or by the persons under my control to
Others :
Thoroughly ventilated Fire hose run out and pressurized Provided with suitable access and egress
Closed by(Subcontractor) Accepted by (HEC HOD) Registered by (Permit Coordinator/HEC HSE)
Gas test required Fire resistance blanket/habitat erected Area free of flammable/combustible materials Date Time Date Time Date Time
Signed Signed Signed
Maintain radio contact Depressurized Earthed for static
Water flushed Secure loose objects Drained free of liquids
Firewatcher present Containers for welding rods to be provided System Electrically Isolated ※ NOTE
EXCAVATION WORK PERMIT Area to be provided with suitable acess and egress
During work
Underground survey for un-identified objects in place
Area is isolated by barriers and signs

Machine guarding and toolbox talk to be in place
Suitable PPEs for all personnel

JSA strickly followed Safe load working for all equipment to be followed Bankman is provided at all time
Compnay Name:- ______________________
Permit Registry No.
Traffic prevention procedure in place at all time Soil survey and slope checked by competent persons Stop work if unexpected condition found
After work The trench area to be left clean and safe secure conditions Plant/equipment to be removed to safe parking area
Others :
Work Description :
Reason for excavation / piling :
Nearest Unit No. / Structure :
Size of excavation : Length - Mts. Breadth - Mts. Depth - Mts.
Equipment & Tools to be used : Hand tools Excavator Trucks Compressor Vibrator
Others :
Elec. tools Bulldozer Others :
Dewatering system required : Yes No
Details Date Authorized Gas Tester
8 hourly Time Name
Requested by : Signed : ※ Task must be clearly described. 4 hourly Combustible (%) Initials
Continuous Toxic/H2S Date
3. SAFETY CHECK
Other : Oxygen (%) Time
A. CIVIL / MECHANICAL SECTION ※ Initialled by Authorized Gas Tester as being within acceptable gas test limits. ※ Usable O2 CH4 H2S
※ Comments/Remarks : other sheet CO Other
Area free including telephone cables : Yes No Area free including Pipelines / Drains : Yes No
7. APPROVAL & ISSUE
Depth of cable, if knows : Mts. Depth of Pipeline / Drain, if knows : Mts.
Step1. Prepared by ( Subcontractor Engineer )
Safety checks YES NO Safety checks YES NO Safety checks YES NO
Date : Time : Name : Signed :
Shoring required Hazard indicating light required Concrete paved area
Comments :
Area barricading required Road block required
Step2. Reviewed by ( HEC-HSE Authorized Representative )
Special instructions, If any :
Comments :
B. ELECTRICAL SECTION
Step3. Approved by ( HOD-Construction Authorized Representative )
Area free including telephone cables : Yes No Type of cable : HV MV LV NA
Depth of cable, if knows : Mts. Others : Comments :
Step4. Accepted by (Subcontractor Task Supervisor / Site Manager)
Safety checks YES NO Safety checks YES NO Safety checks YES NO
Power cable present in the area Protection for existing cables required Hand digging allowed I have read and understand the above conditions and precautions and declare that I accept responsibility for
Electrical isolation required Mechanical digging allowed carrying out work specified on this Permit, that no attempt will be made by myself or by the persons under my control to
Special instructions, If any : carry out any other work, and that I will notify the Contractor engineer(HEC) upon completion/suspension of this work.
C. HSE(SAFETY) DEPARTMENT CHECKS
8. RE-VALIDATION ( Compulsory RE-VALIDATION of the work permit each shift - to Continue work )
Road Closure : Yes No If yes - Give full details :
Date Validity Time Subcontractor HEC HEC - HSE Date Validity Time Subcontractor HEC HEC - HSE
Safety Equipment : Road Signs Barriers Flashing Lights Traffic Lights
Other Instructions : Signature Signature Signature Signature Signature Signature
3. HAZARDS IDENTIFIED
Overhead Power line Overloading Equipment Deep excavation(>2m) Soft / Wet ground Signature Signature Signature Signature Signature Signature
Limit of access Moving Machinery Confined Space Tripping Hazard
Collapse Water accummulation Underground facilities is hidden Unknown ground conditions
Closed by(Subcontractor) Accepted by (HEC-HOD) Registered by (Permit Coordinator/HEC HSE)
Bad weather affected Nightshift
Others : Signed Signed Signed
Before starting Drawings, Method statement has been approved Barriers and signs to be in place ※ NOTE
LIFTING WORK PERMIT Firewatcher present
Work area kept wet
Compnay Name:- ______________________
Permit Registry No.
Others :
Work Description :
2. SAFETY CHECK
Others :
Item YES NO NA* Details 6. GAS ANALYSES OR INITIAL GAS TEST(Authorized Gas Tester)
1. Crane operator holding valid licence NO: Vaildity: Details Date Authorized Gas Tester
2. Crane travel routes determined 8 hourly Time Name
4 hourly Combustible (%) Initials
3. Crane operating area determined Continuous Toxic/H2S Date
4. Crane sitting on firm foundation Other : Oxygen (%) Time
※ Initialled by Authorized Gas Tester as being within acceptable gas test limits. ※ Usable O2 CH4 H2S
5. Area roped off & warning signs displayed ※ Comments/Remarks : other sheet CO Other
6. Crane safe distance from excavations 7. APPROVAL & ISSUE
7. Overhead power cables protected Step1. Prepared by ( Subcontractor Engineer )
8. Equipment facilities in vicinity guarded Date : Time : Name : Signed :
Comments :
9. All safe guards funished Step2. Reviewed by ( HEC-HSE Authorized Representative )
10. Crane, lifting gear certified, tested Date : Time : Name : Signed :
Comments :
11. Crane, lifting gear colour coded
12. Signalman/ flagman in position Name : Step3. Approved by ( HOD-Construction Authorized representative )
13. Other necessary precautions Comments :
Others :
NA * - Not Applicable carrying out work specified on this Permit, that no attempt will be made by myself or by the persons under my control to
Others :

CONFINED SPACE ENTRY PERMIT Erect signs and barriers
JSA
Keep work site free of trip hazards
Comply with MSDS
Adhere to lifting plan/method statement
Equipment to be isolated when left unattended

Compnay Name:- ______________________
Permit Registry No.
Others :
Work Description : INITIAL ENTRY NORMAL ENTRY
Others :
2. SAFETY CHECK
8 hourly 4 hourly Continuous Others : Authorized Gas Tester
YES NO NA* YES NO NA* Date Name
A. Equipment Preparation 7 Have minutes of prescribed been reviewed Time Initials
1 Has been thoroughly drained 8 Are adequate gas analysis Combustible (%) Date
2 Has been isolated by 9 Are cordoning / warning sign put up Toxic/H2S Time
- Blinds Oxygen (%)
Signature
- Disconnecting C. Adjacent work site precautions Signature
3 Has been water flushed 1 Is hazards from adjacent work taken into ※ To be performed at least every 8hrs ※ Usable O2 CH4 H2S
4 Has been steamed consideration ※ Initialled by Authorized Gas Tester as being within acceptable gas test limits. other sheet CO Other
5 Has been purged with inert gas 2 Are close by sewage drains etc., sealed ※ Comments/Remarks :
6 Has been ventilated
7. APPROVAL & ISSUE
B. Site preparations/ precautions D. Prime mover and other isolations
1 Will lighting be used during entry 1 Has been mechanically isolated Step1. Reviewed by ( Contractor Engineer )
2 Is the site cleared of combustible/toxic 2 Has been isolated from other power sources Date : Time : Name : Signed :
materials 3 Electrically isolated and tagged Comments :
3 Is adequate fire-fighting equipment 4 Has power source been disconnected Step2. Reviewed by ( HSE Authorized representative )
located to the work site Isolation slip No. Date : Time : Name : Signed :
4 Are entry and escape adequate (ladder etc.) 5 Has been isolated from radio active source Comments :
5 Have monitoring personnel been
adequately equipped and informed Step3. Approved by ( Construction Authorized representative )
6 Are life-line, safety harness and breathing Date : Time : Name : Signed :
equipment readily available NA * - Not Applicable Comments :
3. HAZARDS IDENTIFIED
Extreme weather Flammable materials Explosives Noise High Voltage
carrying out work specified on this Permit, that no attempt will be made by myself or by the persons under my control to
Confined space Electrical Spark Danger of falling Tripping/Slipping Hazard Low Voltage carry out any other work, and that I will notify the Contractor engineer(HEC) upon completion/suspension of this work.
Awkward Access/Egress Welding sparks Vehichle Traffic Hot materials Manual handling Date : Time : Name : Signed :
Toxic gases/fumes Eqpmt causing sparks Lifting operation Working at Height Severe/Adverse Weather 8. RE-VALIDATION ( Compulsory RE-VALIDATION of the work permit each shift - to Continue work )
Limited/poor lighting Moving machinery Pintch points Live Equipment Sharp edges Subcontractor HEC HEC - HSE Subcontractor HEC HEC - HSE
Date Validity Time (Task Supervisor) Site in-charge (Coordinator) Date Validity Time (Task Supervisor) Site in-charge (Coordinator)
Others :
4. PRECAUTION TO BE TAKEN Signature Signature Signature Signature Signature Signature
Gas test required Fire resistance blanket/habitat erected Area free of flammable/combustible materials
Closed by(Subcontractor) Accepted by (HEC CM) Registered by (Permit Coordinator/HEC HSE)
Water flushed Secure loose objects Drained free of liquids Signed Signed Signed
Firewatcher present Containers for welding rods to be provided System Electrically Isolated
Firewatch extinguisher Work area kept wet System Mechanically Isolated ※ NOTE
RADIOGRAPHY WORK PERMIT Radiation areas barricaded Caution notice posted Radiation area boundaries monitored
Site e-mail notification Warning lights positioned Intergration monitor
Compnay Name:- ______________________
Permit Registry No. Radiation meters checked & colibrated Adequate signs positioned Adequate survey meters
THIS PERMIT IS AUTOMATICALLY SUSPENDED UPON ACTUATION OF THE GENERAL ALARM Remote handling equipments checked Sealed source container checked Film badge worn
Others :
Work Description :
2. SAFETY CHECK
Others :
YES NO NA* YES NO NA*
1 Is adequate warning given to persons in the 5 Are other plants informed
Details Date Authorized Gas Tester
area prior to and during radiographic work
6 Are other work permits withdraw 8 hourly Time Name
2 Is evacuation of all non-radiography personnel 4 hourly Combustible (%) Initials
7 Is adequate percaution taken to prevent
from the unsafe area is done Continuous Toxic/H2S Date
triggering of UV detector
Other : Oxygen (%) Time
3 Are safety features, warning signs and barriers
Obtain Input From Inspection & Materials ※ Initialled by Authorized Gas Tester as being within acceptable gas test limits. ※ Usable O2 CH4 H2S
erected to pervent persons from entering
Technology (by Responsible Operator) ※ Comments/Remarks : other sheet CO Other
in to the unsafe area
8 Safe distance barrier in meters mts. 8. APPROVAL & ISSUE
4 Are the classified persons doing the job
carrying film badges / dose rate meter 9 Source Strength Curie Step1. Reviewed by ( Contractor Engineer )
Caution : In case of emergency, the radiation source shall be immediately retracted into its exposure protection Comments :
Step2. Reviewed by ( HSE Authorized representative )
container and radiographer shall evacuate the area with radiation source in its exposure protection container.
Comments :
Special instructions, If any :
Step3. Approved by ( Construction Authorized representative )
3. DETAILS OF CLASSIFIED WORKERS CARRYING OUT WORK
Comments :
NAME ID No. License No. Step4. Accepted by (Subcontractor Task Supervisor / Site Manager)
carrying out work specified on this Permit, that no attempt will be made by myself or by the persons under my control to
carry out any other work, and that I will notify the Contractor engineer(HEC) upon completion/suspension of this work.
9. RE-VALIDATION ( Compulsory RE-VALIDATION of the work permit each shift - to Continue work )
Subcontractor HEC HEC - HSE Subcontractor HEC HEC - HSE
Date Validity Time (Task Supervisor) Site in-charge (Coordinator) Date Validity Time (Task Supervisor) Site in-charge (Coordinator)

3. DETAILS OF RADIATION SOURCE
Closed by(Subcontractor) Accepted by (HEC CM) Registered by (Permit Coordinator/HEC HSE)
A X-ray apparatus (make / type) Date Time Date Time Date Time
Signed Signed Signed
B Max tube voltage ( kv )
C Sealed source type Strength curies Cross-Referenced Documents : YES NO
D Serial No ※ NOTE
ELECTRICAL WORK PERMIT Firewatcher present
Work area kept wet
Compnay Name:- ______________________
Permit Registry No.
Others :
Work Description :
2. SAFETY CHECK
Others :
A. Work Requiring Isolation
Item YES NO NA* Details
1. Isolation Plan Provided Details Date Authorized Gas Tester
2. Approved JSA Provided 8 hourly Time Name
3. All switch boxes locked out/ tagged out 4 hourly Combustible (%) Initials
4. Warning notices provided Continuous Toxic/H2S Date
5. Work area fenced or roped off or screened Other : Oxygen (%) Time
6. Apparatus dead provided by test ※ Initialled by Authorized Gas Tester as being within acceptable gas test limits. ※ Usable O2 CH4 H2S
7. Grounding Provided ※ Comments/Remarks : other sheet CO Other
8. Other necessary precautions
7. APPROVAL & ISSUE
B. Work on Live Equipment
Step1. Prepared by ( Subcontractor Engineer )
Item YES NO NA* Details
1. Approved JSA provided
Comments :
2. Safety equipment provided
Step2. Reviewed by ( HEC-HSE Authorized representative )
- Insulation rubber gloves
- Insulation rubber boots
Comments :
- Insulation rubber mats
- Other tools and equipment
Step3. Approved by (HOD-Construction Authorized representative )
3. Danger & caution notice posted & access control
4. Safety training provided
Comments :
5. Other necessary precaution
Others :
NA * - Not Applicable carrying out work specified on this Permit, that no attempt will be made by myself or by the persons under my control to
Others :

PTW (Permit To Work) LOG SHEET
Approval Status
No. PTW No. Type of Sub- Place/ Work Description Issuer Date Issued Due Date Remarks
Permit Contractor System (Item No.) HSE Manager/ Construction
Engineer Permit Manager
Coordinator

Attachment 8.3.3 - Permit To Work Form Rev003 Updated

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Attachment 8.3.3 - Permit To Work Form Rev003 Updated

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Available Formats

관리번호

협력업체 공사담당자 공사팀장

평가등급 : A(허용불가-심각), B(중대), C(보통), D(허용가능), E(작다) HSE 팀장 일시 : (서명)

※ 밀폐공간 작업시 해당 : 작업자 성명 및 휴대폰 번호를 기재바랍니다.

작업상황에 대한 안전조치 사항을 그림 또는 도면, 글씨로 표현

1. 대상작업 (9개 위험작업)

- 고소작업 : 높이 1.8m 이상 고소작업

- 비계작업 : 비계 사용(설치, 해체 포함) 및 틀비계 사용작업

- 거푸집작업 : 갱폼 및 강재거푸집 설치, 해체, 탈형 및 인양작업

- 9개 허가작업중 1개만 선택할 수 있음(즉, 각각의 위험작업에 대해 개별 신청하여야 함)

- 위험성평가 빈도, 강도, 등급은 팝업창 추가 및 등급 자동계산

- 대상 작업 시작 1일전 신청 (예외 : 익일 중량물 취급작업으로 일대 장비 투입시 작업전일까지)

- PTW 재신청 기준 : 사용 건설장비 교체 및 증가시, 작업내용 변경시,

작업기간 연장시(승인 작업기간은 7일 기준), 작업인원 증가시(밀폐공간만 해당)

Maintain radio contact Depressurised Earthed for static

Gas Detection : O2 CH4 H2S CO Other :

Area is isolated by barriers and signs

Suitable PPEs for all personnel

Maintain radio contact Depressurised Earthed for static

Control the working hours Measure the temperature Water station

10. PERMIT CLOSE-OUT ( CLOSURE )

Maintain radio contact Depressurised Earthed for static

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