i engineering

TEMPLATES

Contractor’s Work Permit

TO BE COMPLETED BY THE CONTRACTOR

Contractor Company Name:

Contractor Representative Name:
Worksite:
Location of the Work:
Date:
Period of work Expiry Date

SAFE WORK METHOD

Work Description

Please indicate with a tick (  )

Activities include:

Working on the roof Spray painting Excavation

Pipe Works Working in confined spaces Shuttering
Using power tools Welding or abrasive cutting Trenching
Demolishing Erecting scaffolding Using chemicals
Working at heights Explosives Earth Installation
Hot work Access to high voltage workstation Electrical works
Concrete Work Reinforcement Block Works
Other (Specify)

Note: A work permit, which may be required and specific to the work activity that will be carried out is to be forwarded to the Project
Manager and/or Safety Engineer along with any other relevant work permits.

Do you have a safe work method(s) to undertake the work indicated above and are aware of i engineering’s work methodologies? Please
circle yes / no

Have you been trained in and are you competent in the safe work method(s) as per i engineering work methodologies? Please circle
yes / no

Please insert the signed Risk Assessment as

an Object*

Ref.: IENG/TEM/EHS/018/20 Version: 4.0 Page 1/2

This document is the property of i engineering. It cannot be copied or transferred without prior authorization.
 i engineering
TEMPLATES

DECLARATION

I ………………………………………………………………………………………………… of
…………………………………………………………………
Contractor Representative – please print Company Name

Declare that I/We

a) Have completed the required contractor induction.
b) Have certification and qualifications that are required by legislation.
c) Will cease working, make safe the workplace and contact the project manager and/or safety engineer if I become aware of danger to
myself or others during the period of the contract.
d) Have a current Workers Compensation and Public Liability Insurance Policy in place.
e) Agree to the Contractor EHS Requirements in i-engineering procedure – Contractor Management.

Signed: Contractor Date / /

To be completed by i-engineering Project Manager/Safety Officer

The contractor has been admitted to the site to provide the services as detailed in the contract.
An additional Hazardous Work Permit has / has not been issued.
Contractor EHS Site Induction has been arranged before work will commence on the site

Signed: i-engineering Date / /

Ref.: IENG/TEM/EHS/018/20 Version: 4.0 Page 2/2

This document is the property of i engineering. It cannot be copied or transferred without prior authorization.