General Work Permit S3-F7 V3

EHS GENERAL WORK PERMIT PERMIT NO:

SECTION 1: TO BE COMPLETED BY PERMIT REQUESTOR
Permit Requestor: Name: Company:
Intended Work Area: Building: Level: Room:
Description of Work:

Mandatory Requirements: Method Statement Risk Assessment

Services being worked on: tick those that apply Additional Permits Required: tick those that apply
Electrical □ Mechanical □ Hot works □ Confined Space □
Process equipment □ Utility Systems □ Dig □ Working at Height □
Chemical system □ Structural/Civil □ Fire Protection □ □
Other: Permit Number (S ):
Waste management organized □
Lockout/Tag: Mast be used if any of the following hazard exit
Electrical □ Liquid/free flowing Solids □ Excessive heat □ Moving part □
Safety Information: are you aware of the following
Location of Nearest Emergency Exit: Location of Telephone/Radio:
Location of Nearest Safety Shower /Eye Wash: Location of Assembly Point:
Equipment/Tools to be used:
Hazard Identification and Risk Assessment Yes/ No/ Comment
Is the work area cordoned or barrier placed?
Are chemicals required for the task and has the MSDS been reviewed?
Is lighting and ventilation adequate for the task?
Is there sufficient access/egress in the work area?
Can emergency access/egress routes be kept clear?
List all the hazard associated with the task and all control measures documented, must be implemented & used.
Hazards Control measures

Use the Required Personal Protective Equipment: tick those that apply
Hard Hat □ Eye Protection □ Safety Shoes □ High Visibility Clothing □
Respiratory Protection □ Hand Protection □ Hearing Protection □ Lab Coat / Garb □
Safety Harness □ Others:
SECTION 2: PERMIT APPROVAL
THIS SECTION TO BE SIGNED BY THE PERMIT REQUESTOR AND PERMIT AUTHORIZER
Start date: End date:
Permit valid from:
Start time: End time:
Signature Date Time
Permit Requestor:
Permit Authorizer:
Revalidation
Date Time from Initials Date Time to Initials

SECTION 3 : PERMIT CLOSE OUT

THIS SECTION TO BE SIGNED BY THE PERMIT REQUESTOR AND PERMIT AUTHORIZER
Confirmation that the work has been finished. The area is left safe and clean (any problem: Incident Report need to be done)
Name Signature Date & Time
Permit Requestor:

Permit Authorizer:

File Name : S3-F7 General work permit V3 Page 1 of 1

This document and the information it contains are property of ENOVA and confidential. They shall not be reproduced nor disclosed to any person except to those having a
need to know them without prior written consent of the HSEQ Manager of ENOVA.