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  • PMF-015-HSE-005 v1 NWC Permit To Work Form

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    Abdul Rafeeque
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    This document is a permit-to-work form for a construction project that requires authorization and signatures from the supervision consultant and contractor. It details the activity covered by the permit, including hot work, electrical work, confined space entry, and work at height. The permit is valid for an initial activation period that can be revalidated for further periods by obtaining additional signatures. It also includes spaces to document the activation periods, authorization signatures, and closure information.

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    PMF-015-HSE-005_v1_NWC_Permit_to_Work_Form

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    This document is a permit-to-work form for a construction project that requires authorization and signatures from the supervision consultant and contractor. It details the activity covered by the permit, including hot work, electrical work, confined space entry, and work at height. The permit is valid for an initial activation period that can be revalidated for further periods by obtaining additional signatures. It also includes spaces to document the activation periods, authorization signatures, and closure information.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    39 views1 page

    PMF-015-HSE-005 v1 NWC Permit To Work Form

    Uploaded by

    Abdul Rafeeque
    This document is a permit-to-work form for a construction project that requires authorization and signatures from the supervision consultant and contractor. It details the activity covered by the permit, including hot work, electrical work, confined space entry, and work at height. The permit is valid for an initial activation period that can be revalidated for further periods by obtaining additional signatures. It also includes spaces to document the activation periods, authorization signatures, and closure information.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    CORPORATE PROJECTS Unique Permit Number:

    PROJECT MANAGEMENT <Project ID>/<Serial No.>


    MANUAL

    PERMIT-TO-WORK ................/................

    Contractor Company Name:


    Supervision Consultant Company
    Name:
    Method Statement Title:
    Method Statement Document
    Reference:
    Method Statement Version:
    Method Statement Date:

    AUTHORIZATION AND ACKNOWLEDGEMENT


    Signatures of authorized persons are required in order to activate this Permit-To-Work:

    Authorized by:
    ……………………………………… Acknowledged by: …………………….…………………
    Supervision Consultant Contractor
    Date Date (DD/MM/YYY):
    (DD/MM/YYY): ……………………………………… ………………………………………
    Name Name
    (UPPER CASE): ……………………………………… (UPPER CASE): ………………………………………

    Mobile No.: ……………………………………… Mobile No.: ………………………………………

    VALIDITY
    The Permit-To-Work is valid for defined activity only, based upon an initial activation period. It may be revalidated for further
    activation periods (e.g. for change of shift), provided the relevant authorization and acknowledgement signatures are obtained prior
    to each revalidation.

    Hot work (cutting and welding)............................. Deep excavation....................................................

    Electrical work (live equipment and


    Activity systems)................................................................. Roadworks.............................................................
    covered by
    this permit: Confined space entry............................................. Work at height and fall protection........................

    Connections and interfaces with live, operational Other (specified below by the Supervising
    assets..................................................................... Consultant)............................................................

    If ‘other’, describe the activity below (Supervising Consultant) :

    Consultant Consultant
    Period Date: ....../....../........
    initial
    ........ Period Date: ....../....../........
    initial
    ........
    (1) From ........hrs to........hrs
    Contractor
    ........ (2) From ........hrs to........hrs
    Contractor
    ........
    Activation initial initial
    period(s): Consultant Consultant
    Period Date: ....../....../........
    initial
    ........ Period Date: ....../....../........
    initial
    ........
    (3) From ........hrs to........hrs
    Contractor
    ........ (4) From ........hrs to........hrs
    Contractor
    ........
    initial initial

    CLOSURE / CANCELLATION

    Name: ………………………………………… Signature: ……..…………………….…Date: ……………………..


    Supervision Consultant

    598524538.docx Page 1 of 1

    Users of this system document will only be able to ensure that they are using the current version if it is retrieved from CONNECT at the point of use.

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