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PTW Format Ohs

The document is a Permit to Work (PTW) form used to authorize various types of work, including hot work, confined space entry, and electrical work. It includes sections for work details, hazard identification, required personal protective equipment (PPE), isolation procedures, authorization, work start and completion, and permit closure. The form ensures safety measures are in place before work begins and verifies completion afterward.

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arbind patel
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210 views2 pages

PTW Format Ohs

The document is a Permit to Work (PTW) form used to authorize various types of work, including hot work, confined space entry, and electrical work. It includes sections for work details, hazard identification, required personal protective equipment (PPE), isolation procedures, authorization, work start and completion, and permit closure. The form ensures safety measures are in place before work begins and verifies completion afterward.

Uploaded by

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

PERMIT TO WORK (PTW)

1. Work Details
Permit No.: __________________________

Date of Issue: _________________________

Permit Valid From: __________ To __________

 Type of Work:

 ☐ Hot Work (Welding, Cutting)


 ☐ Confined Space Entry
 ☐ Electrical Work
 ☐ Working at Height
 ☐ Excavation
 ☐ Chemical Handling
 ☐ Other: ______________________________

Job Description:
_____________________________________________________

Exact Location:
_____________________________________________________

Department: __________________________

Person Requesting Permit: __________________________

Contact Number: __________________________

2. Hazard Identification & Risk Control


Potential Hazards Control Measures in Place

_________________ _________________

_________________ _________________

_________________ _________________

3. PPE Required
☐ Helmet ☐ Gloves ☐ Safety Shoes ☐ Goggles
☐ Face Shield ☐ Harness ☐ Respirator ☐ Other: ___________

4. Isolation/LOTO (Lockout-Tagout)
Equipment Isolated? ☐ Yes ☐ No

Isolation Details: __________________________________

LOTO Tag No(s): __________________________________

5. Authorization
Permit Issuer (Supervisor / Safety Officer):
Name: ___________________ Signature: ___________ Date: ___________

Permit Receiver (Person Doing the Job):


Name: ___________________ Signature: ___________ Date: ___________

Area In-Charge (If different):


Name: ___________________ Signature: ___________ Date: ___________

6. Work Start Authorization


☐ All safety measures verified and work can begin.

Authorized By (OHS/Safety Dept):


Name: ___________________ Signature: ___________ Date/Time: ___________

7. Work Completion
☐ Job Completed
☐ Site Cleaned
☐ Tools Removed
☐ Isolation Removed

Work Completed By:


Name: ___________________ Signature: ___________ Date/Time: ___________

Verified By (Supervisor/Safety):
Name: ___________________ Signature: ___________ Date/Time: ___________

8. Permit Closure
Permit officially closed by:
Name: ___________________ Signature: ___________ Date/Time: ___________

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