NIGHT WORK PERMIT Date:

Night work permit can be used where work to be carry after 6:00pm and high risks that need to
be
controlled the type of operation for which this permit could be used includes:
All works
Part A-issue
permit is issued to:
for (specific work to be done) :
undertaken the checks and safety measures
at (location of work)
valid from: _______ Am/Pm To:
Part B- Precaution
Required illumination for the assigned work
Required PPEs are issued
Required respective work permit issued
Tool box talk conducted
Availability of emergency vehicle and driver No:
Part D- completion of work
The work has been completed and the work and
Adjacent areas have been thoroughly inspected to
Ensure no hazard remains
the work has been completed and I have undertaken
the checks and safety measures
After work materials stacked properly at the designate
Closing Permit
The work has been completed and I have undertaken
Am/Pm the checks and safety measures i issued this permit
subject to the minimum precaution I have ticked in
Part D of this permit
Time ___/_____/______
Date:___/____/ ____
Signed:
PMC (Gleeds):
(Subcontractor once completed work)
Part E- Cancellation of permit
This permit to work is cancelled and staffs have
been notified. no more work permit
Time:_____/_____/______
Signed:
PMC (Gleeds):

First aider name and phone number:

Electrician name and phone no:

PART-C ACCEPTENCE

I accept this permit and will ensure the precautions ticked above on part B have been undertaken before
starting work. I also understand the checks and safety measures I am required to undertake after
completion of work
Signed(URC Engineer):______________ Project Manager(URC)_______________ PMC (Gleeds)_______________