LORENZANA FOOD CORPORATION

Sto. Tomas, Batangas

Document Title CONTRACTOR WORK PERMIT

Project/Activity General Information: Job Description:

Project Site:
Contractor Name:
Section Supervising Work:
Contractor Supervisor
Starting Date: Completion Date: _____________

Systems Affected / Notification Required: Permits Required: (Check all that apply)
(Check all that Apply) (Answer all)
Yes No Yes No
Any utility system Hotwork
Electrical system Fire Protection System Disablement
Fire Protection System Confined Space Entry
Tele-Communication Linebreaking
Data-Communication System Excavation Permit
Roof Systems Elevated Works
Parking Lot Lock Out / Tag Out
Road Closure Other (Specify)
Other (Specify): __________

Please allow entry of the following contractor employees to perform wok described from start to completion date of the
project indicated above.

Name Designation
1. _____________________________
2. _____________________________
3. _____________________________
4. _____________________________
5. _____________________________
6. _____________________________
7. _____________________________
8. _____________________________
9. _____________________________
10. _____________________________

Approvals:

Plant Safety Officer Process Owner / Supervisor-in-Charge