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Generic Work Permit Checklist Template

This document is a generic work permit template. It outlines safety precautions that must be ensured before issuing a work permit, including inspecting the work area, providing adequate lighting and PPE, isolating energy sources, and conducting job briefings and training. The permit specifies the contractor, location, nature and duration of work, and requires signatures from the permit generator and issuer.

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Amrith Alexander
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137 views1 page

Generic Work Permit Checklist Template

This document is a generic work permit template. It outlines safety precautions that must be ensured before issuing a work permit, including inspecting the work area, providing adequate lighting and PPE, isolating energy sources, and conducting job briefings and training. The permit specifies the contractor, location, nature and duration of work, and requires signatures from the permit generator and issuer.

Uploaded by

Amrith Alexander
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Generic Work Permit

Project Name: Permit No.:


Contractor Name: Date:
Location:
Nature of Work: Hrs to Hrs
Validity from:
(Trade/s) −−
Description of works to be executed: Total worker

Prior to issue permit, the following points to be ensured:


The work area must be inspected prior to issue work permit. Yes No NA
(1) Work Area is free from any obstruction / hazards & hygienic -
(2) Adequate Illumination arrangement provided -
(3) Scaffold / Ladder / Stairs Inspected -
(4) Energy Source Isolated / Disconnected If Any -
(5) Electrical power supply, RCCB, Earthing and connection Checked "ok"
(6) Fire extinguisher Provided and working -
(7) Is the area display with of Signage and Posters -
(8) Equipment / Tools Inspected and tagged -
(9) Dedicated Supervisor deployed -
(10) Job briefing done to all workers and recorded -
(11) Are the workers gone through the Induction & Specific training -
(12) PPE available and used? (Hard Hat, Safety Shoes & Reflective Vest is hand
Gloves, Mask & Goggles as per minimum requirement.)
(13) All workers Insurance and Medical Fitness certificate is available.
Any special instructions that must be complied with;

CONTRACTOR AUTHORISED PERSON ( PERMIT GENERATOR / HOLDER )


Name of the Permit Holder: Designation:
Signature:

To be filled by the Permit Issuer: (Any specific precautionary measures proposed while carrying out activity)

Permitted to Carry Out Work With Above Safety Precautions:


Name of the Permit Issuer: Designation:
Signature:
Closure of Work Permit:
Name of the Permit Issuer: Designation:
Signature:

Note: For Height Work, Hot Work, Excavation & Confined space a separate work permit to be followed. Permit is
Valid for 8 Hours/ One shift. If the work extended, then new permit to be obtained.
Copy of the Permit to be displayed at site.

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