Permit to Work (PTW)– General Activities
Permit No. Date
Project SMICH&RC DEHRADUN Contractor
Location
Job Description
Time Start End
Name of the Vendor Mobile.
Supervisor No
No. of Labourers: Checked for PPE: Yes No
Material Description (TO BE ENTERED BY THE SECURITY DURING VENDOR'S ENTRY)
1) 4)
2) 5)
3) 6)
A. Safety Precautions (To be listed as per the HIRA / JSA control measures in reference to the job description/activity and
associated risks):
B. Permit Initiation & Issue
Declaration of Contractor:
a. All the above safety precautions have been put in place based on Job safety analysis provided
by my organization and verified by me on ground personally.
b. I shall ensure all the necessary precautions are in place till end of the work & I shall take full
responsibility in case of any deviations or lapses noticed on site.
Permit Initiator
(Contractor PM / Engineer)
Checked & Confirmed By
(Contractor Safety Officer)
Comments by PM/CM The contractor is expected to undertake work at site as per their
Safety Precautions and Job Safety Analysis. In case of any Non-
Conformance (NC) to the above noticed by PM/CM/ Consultant/Client
during site rounds, necessary actions as per Contract/Statutory
conditions shall be recommended to Client.
Page 1 of 2
Permit to Work (PTW)– General Activities
C. Permit Closure:
Details Name Signature, Date & Time
The work has been completed and can be closed
Permit Initiator
(Contractor PM / Engineer)
Checked & Confirmed By
(Contractor Safety Officer)
Comments by Contractor if
any
Page 2 of 2
