ATTACHMENT G

Yansab
NIGHT WORK PERMIT
To be completed by contractor supervision

Contract #: PKG # Date:

Manpower: Contractor: Area:
RESPONSIBLE SUPERVISION (Please print name)

Contractor Supervisor Subcontractor Supervisor Subcontractor Foreman

Superintendent on call: Telephone Number:

(Print Name)

DESCRIPTION OF THE WORK

REQUIREMENTS

Is sufficient lumination provided? Yes/No Are additional permits needed? Yes/No

Are all employees equipped with clear safety glasses? Yes/No Is Security notified of the night work? Yes/No
Is there an ambulance and nurse present? Yes/No Is the required safety coverage provided? Yes/No

Attach this permit to the Safe Work Plan

APPROVALS

Superintendent ________________________ Safety Supervisor: _____________________

Construction Manager ______________________ Owner Safety _____________________

Date ______________________ Date: ____________________

HAZARDS SAFEGUARDS

ATTACMENTS: Area plotplan clearly indicating work location and lighting positions.

27g-Night-Work-Permit.xls