CONTRACTOR'S WORK PERMIT

Property: Contractor's copy

DP DS CP Vanilla SO Copy
DCS DSB DWC
Date : _____________________________
Contractor : Authorized by : ______________________________________
Name of Project in charged: Property Maintenance Supervisor/Manager
Signature Signature : _________________________

Approved by : _______________________________________
Safety Officer
Signature : ________________________

What type of Hazardous work? Description of work

1.1 Confined space work

1.2 Electrical work
1.3 Hot work/welding work
1.4 Work on heights
1.5 Cold Work (carpentry/painting etc) Start Time
1.5 Others : Pls Specify Finish Time

Is there any requirement of utility connections such as Yes Has all the workers been oriented on Safety?
water, electricity, compressed air? If yes, inform
in charge of Facility Utility Section No Has the work area been examined ans inspected?

A. Provide List of Equipment and Tools to be used: (pls. attached list of equipment and tools)

Days Activities for 6 days

1
2
3
4
5
6

B. List of workers
(Please attached other sheet indicating worker's name and designation.)

To be filled out by Safety Officer (Property) after revalidation To be filled out by engineering/Project in Charge before and after work
Days Date Name/Signature Time of inspection Name Date Time
1 am In:
pm' Out:
2 am In:
pm' Out:
3 am In:
pm' Out:
4 am In:
pm' Out:
5 am In:
pm' Out:
6 am In:
pm' Out:

Remarks:
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DS-FORM-001-00