{OrganisationBanner}

Doc No: {DocumentNumber}

Permit To Work Report - {JobTypeName} (Permit UID - {PermitToWorkUId})

Type of permit{JobTypeName}
Name of project/ site{SiteName}
Contractor company{CompanyName}
Name of client/ contractor{RequestedByName}
Work location{WorkLocation}
Scope of work{ScopeOfWork}
Work permit start date{PermitToWorkStartDate}
Work permit start time{PtwStartTime}
Work permit close date{PermitToWorkEndDate}
Work permit close time{PtwEndTime}
No. of workers{NoOfWorkers}
Tools/ equipments to be used{ToolsUsed}
Description of work{WorkDescription}
Reference permit no.{ReferencePermitNumber}
Hazards
    {Hazards}
Precautions taken
    {Precautions Taken}
Toolbox talks{ToolboxTalks}
PPEs
    {Job Specific PPEs}
Safety considerations
    {Safety Considerations}
Approval and authorization
Contractor/ client (Requestor/holder) Contractor safety officer (Issuer) Client safety (Reviewer) Client work/tower in-charge (Approver)
Name: {RequestedByName}
Phone: {RequestedByMobileNumber}
Requested On: {RequestedOn} 		Name: {IssuedByName}
Phone: {IssuedByMobileNumber}
Issued On: {IssuedOn} 		Name: {ReviewedByName}
Phone: {ReviewedByMobileNumber}
Reviewed On: {ReviewedOn} 		Name: {ApprovedByName}
Phone: {ApprovedByMobileNumber}
Approved On: {ApprovedOn}
  • Requestor: I accept the conditions stated on the permit & certify that all persons under my control will be made fully aware of the method statement, aspects/hazards as well as associated risks/control measures.
  • Issuer: I hereby certify that the Checks/ precautionary measures as mentioned in the previous sections are confirmed. The permit requester has been informed of all the conditions stated in the SOP, aspects/hazards as well as associated risks/ control measures.
  • Approver: I hereby certify that all the control measures have been verified and found complied, on job trainings have provided as required.
  • Reviewer: I hereby certify that all the control measures have been verified and found complied, on job trainings have provided as required.
{Extensions}