COLD WORK PERMIT No.

C
Dammam Airports Company CWP01 (10/17)

Section 1 – Work Description

Month ………................. Day ……….................. Year ………................. Duration ………..................

A. Identify Facility: …………………………………………………………………………………………………...

B. Exact Work Location: …………………………………………………………………………………………….
C. Work to be done: .......................................................................................................................................
D. Equipment to be used at the site: ............................................................................................................

Stop Work if job site does not meet work permit conditions and any applicable Airport safety
requirements at any time.
Section 2 – Hazard Identification & Control

A. Protective equipment:
Warning Signs □ Barricades □ Fire Extinguisher □
Personal Protective Equipment (PPE) □ Others □ (Explain further in item C below)

B. Isolation Method(s): (Please specify if required)

Locked switch/breaker □ Disconnect □ Mechanical Isolation □
Others □ (Explain further in item D below)

C. List any additional Safety Precautions:

...........................................................................................................................................................................
...........................................................................................................................................................................

D. Other Requirements:
…………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………….

IN AN EMERGENCY:

Section 3 – Permit Authorization & Closure

Org. Counter
Permit User Org: Approver Org:
Sign if applicable
Status Name Signature Name Signature Signature

Open
Countersigner(s)
This Permit is renewed Date: Duration: notified of permit
renewal
Renewed
Countersigner(s)
This Permit is extended Date: Duration: notified of permit
extension

Extended

This Permit is closed Date: Time:

Closed

This Permit is cancelled Date: Time:

Reason:
Cancelled
……………………………………………….