LOADING PERMIT TO WORK

(STORAGE LOADING & UNLOADING ON ABOVE FORMWORK)

Project: Date:
Location: Permit Number:
Section: 1 (Check by site engineer)
Ite Specifications to achieve Yes N N/A Remarks
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1. Are the props to be fixed up to the surveyor mark level?
2. Are the Universal Tripod to be fixed to prop on Surface to hold the Main Props?
3. Are the Universal fork fixed over the props?
4. Are Primary Aluminum Beams fixed & alignment to be arranged on universal fork head?
Are the secondary beams fixed & levelled by clamps and secondary props to be placed over the
5. aligned primary beams?
6. Are the ply fixed on the secondary beam shutter?
7. As per the formwork plan supporting props are fixed?
As per the Scaffolding Design, Maximum Distance between Secondary Beams & Max. Distance for
8. Primary are maintained?
9. Are the slab formwork plywood are laid without gaps?
10. Are the damaged plywood repaired or replaced?
11. Are the formworks for drop beams checked for dimension and correct levels?
12. Proper horizontal bracing & spaced tie rods are provided?
13. Are the jacks/props checked for stability and proper fixing?
14. Are any jacks are not meeting the requirements, replaced immediately?
15. Are the Formworks shall be firmly supported and individual panels shall be rigid?
16. Access is available to Climb over the form?
Are the Formworks Supports Shall be inspected for Spacing and Loading Capacity to match the
17. Approved From Drawings?
Section: 2 (Check by safety officer)
Ite Safety Precautions taken Yes N N/A Remarks
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1. Are standard life line provided?
2. Are standard edge barricades are provided?
3. Are all working with required PPE?
4. Are adequate safety signs are posted?
5. Are proper access / egress provided?
6. Materials are arranged properly and provided good housekeeping?
1. Supervisor Acknowledgement:
I will monitor the work that is to be carried out and will ensure the above mentioned necessary safety precautions are followed at all times, I will complete this task in safe method and I accept responsibility for this work.
Supervisor Name:
(Permit Receiver) Signature:
2. Checked and approved by Acknowledgement: 3. EHS Department Acknowledgement:
The above mentioned specifications are checked as per design, WMS and standard. No objection for performing I have checked above control measures and the work area is safe to carry out the activity.
work (including Storage, loading & unloading) on the above formwork.
Concerned Engineer: Name: SAFE TO WORK UNSAFE TO WORK
(Permit issuer) Signature: Safety officer Name:
Permit Validity Period (Time): From: To: Signature:
4. Closed Out:
This is to certify that the works described above have been safely completed / stopped / area has been restored to a safe and orderly condition.
Name: Name:
Concerned Engineer:
Signature: Safety officer
(Permit issuer) Signature:
Closed Out Time:

GCC/PTW-SL&ULAF/QEHS/Rev.03_03032022