Professional Documents
Culture Documents
Permit To Work Procedure
Permit To Work Procedure
Employer
Rev 0
For Contractor
Prepared by: Checked By:
Name: RUTHCHELLE M. CAMPOS Name: WANG WEI
Position: Safety Officer Position: Project Manager
Signature: Signature:
Date:
1
PERMIT TO
WORK
PROCEDURE
DOCUMENT APPROVAL
NAME POSITION SIGNATURE
PREPARED BY: RUTHCHELLE M. CAMPOS HSE Officer
REVIEWED BY: FERDINAND L. SECULLES HSE Manager
APPROVED BY: ZHU TENG Site Manager
2
TABLE OF CONTENTS
page
What is Permit To Work System? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
How is work controlled within the Permit To Work System? . . . . . . . . . . . . . .3
Types of Permit To Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Permit Issuer Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Permit Receiver Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
HSE Permit Coordinator Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . 4
Operational Procedure for Work Permit System . . . . . . . . . . . . . . . . . . . . 4
Re-validation of the Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Emergency Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Work Permit Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Cold Work Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Excavation Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Electrical Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Confined Entry Space Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Hot Work Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Lifting Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Work at Height Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Equipment Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Appoinment Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
3
Permit To Work
What is Permit To Work System
• The PTW system is a formal written procedure used to control access and activities of
personnel in the construction.
• To ensure safety of personnel and to prevent damage to equipment.
• It also means of communication between site management, supervisors and operators,
who carry out the work.
• PTW normally implemented in a work activities near or inside the operating facilities,
there's buried or near operational system or where the clients thinks that PTW is deemed
necessary.
Permit Issuer Responsibilities (Project Manager/Site Manager, Site Engineer & HSE Manager)
• The Issuer has the sole authority to issue the permit.
• The Issuer shall be fully aware of site conditions, the type of work to be carried out and all
the requirements stated in the permit.
• The Issuer shall conduct an onsite inspection jointly together with the Receiver to ensure
that site conditions are safe to permit the work and all requirements stated in the permit are
implemented prior to the issuance of the permit.
• The Issuer shall withhold the issuance of the permit if the requirements are not met, or site
conditions are not safe for the work to carry out.
• The Issuer shall, if noticing the presence of any other potential hazards, risks that may
jeopardize the safety of the worker, tools or equipment advice the Receiver of appropriate
countermeasures to be taken.
• The Issuer shall ensure that all required safety monitoring measurements are properly
done and so stated in the permit.
• The Issuer shall ensure all personnel involved in the work are fully aware of Emergency
procedures.
4
• Once informed the work is completed, the Issuer shall visit the site jointly with the
Receiver to ensure that the work is ceased and the site is kept clean and tidy without any
smouldering exist.
NOTE:
“In absence of the HSE Manager, his Deputy may take charge and shoulder all
the responsibilities.”
Permit Receiver Responsibilities (Site Manager/Site Engineer/Foreman & Safety Officer on site)
• The Receiver shall be fully aware of all requirements stated in the permit and comply with
them at all times.
• The Receiver shall fully brief the work crew to ensure that requirements are clearly
understood by the crew under his supervision.
• The Receiver shall ensure the work is performed in accordance with the conditions
specified in the permit. He shall remain at the work site to supervise the work.
• The Receiver shall ensure that under no circumstances shall by his own discretion or his
crew change the original scope of the work, which is described in the permit.
• Whenever site conditions are drastically changed, the Receiver shall immediately stop the
work and inform the Issuer of the change for further instruction from him.
• Upon the occurrence of an emergency the Receiver shall immediately stop the work and
shut down all equipment.
• The Receiver shall report the completion of the work or the expiration of the validity of the
permit to the Issuer and ensure that the site is kept clean and tidy without any smouldering/ignition
sources.
• If the work in progress requires extending the validity stated in the permit, the Receiver
shall request an issuance of new permit.
5
5. The Receiver shall produce the permit to Contractor responsible personnel for the work
requested in the permit for review and verification prior to the commencement of the work.
6. As soon as the review and verification has been made, the Receiver shall bring the verified
permit to the HSE Permit Coordinator.
7. The HSE Permit Coordinator shall scrutinize the permit including safety precautions and
requirements stated in the permit and deliver it to the Receiver. The HSE Permit
Coordinator should consult HSE personnel for professional advice or suggestions required to
work safely.
8. The Receiver shall bring the permit to the Issuer who shall review the permit to ensure that all
required safety precautionary measures are stated and authorizes the permit.
9. On the day of the work, the Issuer in the person together with the Receiver shall go to the site to
ensure that all requirements in the permit are met and hand over the permit to the Receiver
10. Issuance of the permit to the Receiver in the office shall not take place.
11. Upon receipt of the permit from the Issuer, the Receiver can commence the work.
12. When no further work is to take place under a permit, the Receiver shall sign off and
return the permit to the Issuer to close the permit.
13. Upon receipt of the permit, the Issuer and the Receiver shall inspect the work site to
ensure that no smouldering is present, the work site is clean and tidy and equipment is left
in a safe condition.
“The issuer shall return the invalid permit to the HSE Permit Coordinator for file.”
Emergency Situation
• When an emergency, such as a fire incident, Toxic Gas Release, Natural calamities has
taken place the Receiver shall immediately stop all works and shut down all equipment.
• All permits shall be nullified and no work shall be resumed unless new permits have been
issued out by the Issuer.
• Prior to the issuance of a new permit, the Issuer shall visit the work site to ensure that
there is no imminent hazard/risk present and that the work site is safe for work.
Summary
• The Permit to Work is designed to provide a safe system of work that can be applied to
works identified by virtue of perceived risks.
• This shall be applied to the Contractor controlled Construction activities on the Project.
• Permit requirements for activities other than those mentioned in this procedure will be re-
evaluated especially for potentially hazardous activities where an extra degree of work control is felt
to be appropriate.
6
WORK PERMIT FLOW CHART
Permit Receiver
(Site Manager, REVIEW/VERIFY Permit Issuer
CLOSE PERMIT
Site Engineer/ PERMIT & Receiver
Foreman &
Site Safety Officer)
YES
Permit Issuer
(Project Manager/
AUTHORIZE PERMIT CARRY OUT WORK WORK FINISHED?
Site Manager,
Site Engineer &
HSE Manager)
7
COLD WORK
PERMIT
8
9
Rev. No. 002
Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Project / Site
Permit Issuer Name: Contact No.
Manager Sign
(SUMEC)
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Daily Checklist of Heavy Equipment Shelter for workers provided
Training induction of workers completed Toolbox Attendance/Meeting conducted
Machine Operated by Certified Operator Materials properly store and arranged
Personal Protective Equipment for workers provided Ladder use inspected
Area work clean and tidy Workers away from a moving heavy equipment
Material proper arrangement Adequate illumination during night work
Rest Shelter First aider certified and availability at site.
Enough Drinking Water for the worker Safety coverage on site.
Area barricaded Waste material segregated
Housekeeping being conducted Access clear of obstruction.
Declaration by the permit requester/receiver
Work shall be carried out only after complying with the precautions given in the section III of permit
This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)
A cold work permit typically outlines the specific tasks to be performed, the associated hazards, and
the precautions that must be taken to mitigate the risks. The permit may also include information
on the duration of the work, the personnel involved, and the necessary equipment and tools
required to complete the job safely.
11
EXCAVATION
PERMIT
12
Rev. No. 002
Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Has services indicated by walk through with Water / Sewer / Irrigation / Drainage
operatives designated to the task and safe (1m exclusion)
exclusion zones been indicated by barriers
Has a Risk Assessment been completed for the Has area been checked under ground utilities
task of excavating
Have the Operatives for the task been briefed on Are all service locations clearly marked?
the Risk Assessment. Is this signed for?
Are required controls in place as per the Risk Necessary trial trenches been excavated
Assessment?
Electrical 11kV or higher voltage (3m exclusion) Telecommunications (1m exclusion)
Overhead services (Contact Service Owner) Oil/Gas (10m exclusion)
Other (including structures)
Declaration by the permit requester/receiver
Work shall be carried out only after complying with the precautions given in the section III of permit
This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)
14
ELECTRICAL
PERMIT
15
Rev. No. 002
Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
Details of the 220 volt power tool ✔for Yes and X for NO Y/N N/A
Types of Power Tool ELCB tested and certified
Drill £ Breaker £ Others £ Industrial sockets (blue) in use
Reason for using the equipment:
Armored cable
Toolbox talk on use of 220 volt elec.
Equipment is adequately earthed
Safety warning signs in place
Dead Man's switch functioning
Manufacture
Double insulated casings
Work shall be carried out only after complying with the precautions given in the section III of permit
This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)
Examples of electrical work that may require an Electrical Work Permit include:
Installing or repairing electrical equipment may include installing or repairing motors,
generators, transformers, switch gear, or control panels. A permit ensures that proper safety
measures, such as locking and tagging out the equipment, are in place to prevent accidental
contact with live electrical parts.
Electrical maintenance may include cleaning, lubricating, testing, or adjusting electrical
equipment. A permit ensures that proper safety measures, such as wearing appropriate PPE
and using proper tools, are in place to prevent electrical shocks and burns.
Troubleshooting electrical problems may involve testing or measuring electrical circuits or
equipment to diagnose problems. A permit ensures that proper safety measures, such as de-
energizing the equipment and using proper test equipment, are in place to prevent electrical
accidents.
Modifying electrical systems may include adding or removing electrical circuits, changing wiring,
or upgrading equipment. A permit ensures proper safety measures, such as disconnecting and
isolating the equipment, are in place to prevent electrical hazards.
Testing and commissioning electrical systems may involve testing newly installed equipment or
systems to ensure they function properly. A permit ensures proper safety measures, such as
using proper test equipment and following testing procedures, are in place to prevent electrical
accidents.
17
CONFINED
ENTRY SPACE
PERMIT
18
Rev. No. 002
Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Atmosphere in the confined space tested If so, are the equipments isolated
Oxygen level is 19.5% (should not be less/more) Is the main source of supply tagged?
Will the atmosphere be monitored during work? Has the toolbox talk been given?
Continuously/Periodically specify interval Air intake system located free from fume
Has the space been ventilated before entry Preparedness for emergency response?
Will ventilation be continued during work?(LEV) Work method statements submitted?
Was the space foubd unacceptable? Will any chemicals be used in the space?
If so, after ventilation was the area retested? Adequate illumination to carry out job?
Are there any other equipment running? Appropriate PPE provided
Will any other equipment be used in the space? Watcher/s required
Declaration by the permit requester/receiver
Work shall be carried out only after complying with the precautions given in the section III of permit
This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
19
REMARKS:
ENTRY LOG
Attendant (s): Confined Space Name:
Attendant:
Rescue Equipment Requirements (check where applicable below and indicate quantity needed):
Hauling Systems: Carabiners: Pulleys: Shock absorbers/lanyards: Anchor
Straps: Webbing: Ascenders: Body Harnesses:
Rigging Plates: Safety Lines: Main Lines: Wrist/Ankle Harnesses:
O Fire Extinguishers: Others:
Rescue Equipment Inspections
Identified rescue equipment inspected by competent worker: Company: Record
Yes No
Medical Equipment Requirements (check where applicable below and indicate quantity needed):
First Aid Kit: O Other Device:
21
ON-SITE RESCUE
PROCEDURES
These Procedures and the associated On-Site Rescue Plan are part of the written plan for the confined space
and are based on an evaluation of the risks in this area.
1. The associated "on-site rescue plan" for the confined space must be completed, and the entry
supervisor must make sure that all the rescue tools needed to carry out a rescue inside the confined
area are on hand.
2. The entry supervisor will make sure that there are adequate qualified individuals on hand to carry
out these on-site rescue procedures for the confined area as specified in the "on-site rescue plan"
that is attached.
4. Using the methods outlined in the "on-site rescue plan" attached, the attendant initiates
communication with all employees.
1. According to the attached "on-site rescue plan," the attendant who is stationed outside and close to the
restricted space's entrance keeps in constant contact with all employees inside the area.
space rescue:
The attendant does not enter the confined space but immediately summons a rescue response from the on-
site rescue team, using the means of communication described in the attached “on-site rescue plan”.
22
Confined Entry Space Permit
A Confined Entry Space Permit is a formal document granting permission to work within a
confined space. Confined spaces are areas that are large enough for a person to enter and
perform work but have limited means of entry and exit and are not designed for continuous
occupancy. These spaces can present a variety of hazards, such as toxic atmospheres,
oxygen deficiency, engulfment, or entrapment, which can lead to serious injury or fatality if
not properly managed.
Some examples of tasks that may require a Confined Entry Space Permit include the
following:
Cleaning or maintenance of tanks, vessels, or silos: These confined spaces may contain
hazardous chemical residues or lack adequate ventilation, leading to dangerous
atmospheres. A confined entry space permit ensures that all safety protocols are
followed, such as purging and isolating the space, ventilating the area, and using gas
monitors to detect hazardous atmospheres.
Inspection, repair, or maintenance of sewers or underground utility vaults: These spaces
can present risks such as engulfment, oxygen deficiency, or toxic gases. A confined
space permit ensures workers know the hazards, wear appropriate PPE, use gas
monitors, and follow proper entry and exit procedures.
Working inside pipelines, ducts, or tunnels: These confined spaces can have limited
access and egress, making it difficult for workers to escape in an emergency. A confined
space permit ensures that proper communication and rescue procedures are in place
and that workers are trained to work safely in these environments.
23
HOT WORK
PERMIT
24
Rev. No. 002
Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Flammable materials removed from location Appropriate working platform
Welding genset terminal insulation Safety warning signs in place
Adequate Earthling Adequate ventilation
Area of work clean and dry Condition of the welding cables
Appropriate fire extinguisher provided Adequate illumination
Operatives trained in using fire extinguisher Flashback arrestor - gas cylinder
Fire blankets (non-flammable) provided Cylinder in trolley and secured
Fire watch personnel Regulator in good condition
Area barricaed Gas test required
Appropriate PPE provided Isolation of equipment required
Declaration by the permit requester/receiver
Work shall be carried out only after complying with the precautions given in the section III of permit
This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)
A Hot Work Permit is a formal document that grants permission to perform work involving
open flames, sparks, or other high-temperature sources. Hot work includes activities such
as welding, cutting, brazing, grinding, and other similar tasks that generate heat, sparks, or
flames. These activities can present significant fire and explosion hazards, leading to serious
injury or damage to property if not properly managed.
Here are some examples of tasks that may require a Hot Work Permit:
Welding or cutting metal structures or equipment involves using an open flame or arc to
join or cut metal parts or structures. A hot work permit ensures proper fire prevention
measures, such as removing flammable materials from the work area and using fire
blankets to contain sparks.
Grinding or sanding of metal surfaces: Grinding or sanding metal surfaces generates
heat and sparks, which can ignite flammable materials in the work area. A hot work
permit ensures proper ventilation, and PPE is used to minimize the risk of fire or
explosion.
Brazing or soldering of pipes or other components: These activities involve using heat to
join metal components without melting them. A hot work permit ensures that proper
26
fire prevention measures are in place and that workers use appropriate PPE and
ventilation.
Thawing of frozen pipes: Using heat sources such as torches can create fire hazards due
to flammable materials in the work area. A hot work permit ensures proper safety
measures, such as heat-resistant shields and PPE, are in place to minimize the risk.
Roofing work involving torches: Torch-applied roofing involves using open flames to seal
and install roofing materials. A hot work permit ensures proper fire prevention and
control measures, such as fire-resistant roofing materials, fire extinguishers, and fire
watchers.
Demolition work involving cutting or burning of materials: Demolition work involving
cutting or burning of materials can generate heat and sparks, which can ignite
flammable materials in the work area. A hot work permit ensures proper safety
measures, such as removing flammable materials from the work area and using
appropriate PPE and ventilation.
Heating or thawing equipment or pipelines involves using heat to thaw or warm
equipment or pipelines, which can pose a fire hazard if proper safety measures are not
in place. A hot work permit ensures workers use appropriate PPE and fire prevention
measures, such as fire-resistant blankets and fire extinguishers.
27
LIFTING
PERMIT
28
Rev. No. 002
Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Lifting procedure/prepared/planned? Doors and windscreen good condition
Crane inspected/Jibs good condition Main brake system funtioning
Work area in safe-condition Safety/Warning signs in place
Lifting calculation completed/Load Test/Charts Winch brake system functioning
Dedicated signalman (one person only) with vest Ground stability checked
Area supervisor/safety personnel supervision Stability of crane outriggers
Height clearance completed Weather in good condition
Shackles inspected Fire extinguisher in place
Sling inspected with certificates Steel plates (where required)
Spreader bar inspected Area barricaded
Declaration by the permit requester/receiver
Work shall be carried out only after complying with the precautions given in the section III of permit
This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)
Name/Sign Name/Sign
29
Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign
Date: Date: Date: Date: Date: Date: Date:
REMARKS:
LIFTING PLAN
MATERIALS TO BE LIFTED: ____________________________________________________________
B. WEIGHT
1. Empty / Load kg 1. Number of Parts of Cable
2. Allowance for Unaccounted 2. Size of Cable mm
Material in Equipment kg 3. Lenght of Boom m
3. Other Misc. (Water, Concrete, 4. Angle of Boom at Pick-up
Refractory, etc.) kg 5. Angle of Boom at Set
4. Headache Ball kg 6. Capacity of Crane, Severest
5. Block kg Lifting Conditions (from chart)
6. Lifting Bar / Spreader Bar kg a. Over Rear kg
7. Slings & Shackles kg b. Over Front kg
8. Jib: Erected Stowed kg c. Over Side kg
9. Headache Ball on Jib kg d. Capacity of Crane This Lift
10. Cable (Main Fall) kg (from chart) kg
e. Max. Load of Crane kg
TOTAL WEIGHT kg f. This Lift's Percentage of
Crane's Rated Capacity %
30
Lifting Permit
A Lifting Permit is a formal document granting permission to work with a crane or other
lifting equipment. Cranes and other heavy lifting equipment are commonly used in
construction, manufacturing, and shipping industries, where large or heavy loads must be
moved or positioned. Operating cranes and lifting equipment can present significant
hazards, including the risk of loads falling, equipment failure, or structural collapse, leading
to serious injury or fatality if not properly managed.
31
WORK AT
HEIGHT
PERMIT
32
Rev. No. 002
Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Erected by certified scaffolder All board in the working platform firmly secured
with holding clamps?
Is the scaffold strong enough for the load? Has the scaffold been tied with existing features/
structure for stability?
Is the scaffold stable? Access ladder or Safe equivalent provided & used?
Condition of tubes, ladders and board Ladder & working area kept free of debris,
chemical, grease etc
Foundation, ground condition suiltable for the Complete platform, planks, close together &
erection of the scaffold? overlapped by at least 0.3 Mt or secured by wire
or proper cleating
Have all standards been erected on base plates? Guard rails/ handrails, mid rails and toe boards
installed on all open sides of platforms 1 Mt. over
in height
Are timber sole plates provided to prevent Scafft ag been signed and displayed indicating safe
sinking?
Are all standards fixed in true plumb? Training inductionof workers completed
Is the bracing between the standards correctly Toolbox Attendance/Meeting conducted
and rigidly fixed?
All couplers and joining pins correctly and rigidly Access/egress clear of obstruction.
fixed?
Declaration by the permit requester/receiver
Work shall be carried out only after complying with the precautions given in the section III of permit
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Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign
Date: Date: Date: Date: Date: Date: Date:
REMARKS:
Work At Height Permit
Work at height permit is a document that must be completed and authorized before any
work activity can occur at the height of more than two meters above the ground. The permit
is designed to ensure that all necessary precautions have been taken to prevent falls, ensure
workers’ safety, and comply with legal requirements.
Examples of work that requires a height work permit include, but are not limited to:
Working on ladders: Ladders are commonly used to access high places like roofs or
shelves. Any work carried out on a ladder more than two meters above the ground will
require a height work permit.
Working on scaffolding: Scaffolding is commonly used in construction work to provide a
stable platform for workers to access high areas. Any work carried out on scaffolding
over two meters above the ground requires a height work permit.
Working on Mobile Elevated Work Platforms (MEWPs): MEWPs are commonly used in
construction, maintenance, and cleaning work to provide access to high areas. Any work
carried out on a MEWP more than two meters above the ground will require a height
work permit.
Working on roofs: Any work carried out on a roof over two meters above the ground
will require a height work permit.
Working near edges or openings: Work carried out near edges or openings more than
two meters above the ground, such as balconies, windows, or open floors, will require a
height work permit.
Using access equipment: Any use of access equipment, such as cherry pickers or hoists,
to carry out work more than two meters above the ground will require a height work
permit.
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EQUIPMENT
CHECKLIST
38
SN. Description M T W TH F SAT SUN
39
SN. Description M T W TH F SAT SUN
41
SN. Description M T W TH F SAT SUN
42
Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description M T W TH F SAT SUN
44
Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description M T W TH F SAT SUN
45
Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description M T W TH F SAT SUN
48
APPOINTMENT
LETTER
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Permit Issuer Responsibilities
• The Issuer has the sole authority to issue the permit.
• The Issuer shall be fully aware of site conditions, the type of work to be carried out
and all the requirements stated in the permit.
• The Issuer shall conduct an onsite inspection jointly together with the Receiver to
ensure that site conditions are safe to permit the work and all requirements stated in the
permit are implemented prior to the issuance of the permit.
• The Issuer shall withhold the issuance of the permit if the requirements are not
met, or site conditions are not safe for the work to carry out.
• The Issuer shall, if noticing the presence of any other potential hazards, risks that
may jeopardize the safety of the worker, tools or equipment advice the Receiver of
appropriate countermeasures to be taken.
• The Issuer shall ensure that all required safety monitoring measurements are
properly done and so stated in the permit.
• The Issuer shall ensure all personnel involved in the work are fully aware of
Emergency procedures.
• Once informed the work is completed, the Issuer shall visit the site jointly with the
Receiver to ensure that the work is ceased and the site is kept clean and tidy without any
smouldering exist.
_________________________________
Signature above printed Name
Date: ____________________
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Permit Receiver Responsibilities
• The Receiver shall be fully aware of all requirements stated in the permit and
comply with them at all times.
• The Receiver shall fully brief the work crew to ensure that requirements are clearly
understood by the crew under his supervision.
• The Receiver shall ensure the work is performed in accordance with the conditions
specified in the permit. He shall remain at the work site to supervise the work.
• The Receiver shall ensure that under no circumstances shall by his own discretion
or his crew change the original scope of the work, which is described in the permit.
• Whenever site conditions are drastically changed, the Receiver shall immediately
stop the work and inform the Issuer of the change for further instruction from him.
• Upon the occurrence of an emergency the Receiver shall immediately stop the
work and shut down all equipment.
• The Receiver shall report the completion of the work or the expiration of the
validity of the permit to the Issuer and ensure that the site is kept clean and tidy without
any smouldering/ignition sources.
• If the work in progress requires extending the validity stated in the permit, the
Receiver shall request an issuance of new permit.
_________________________________
Signature above printed Name
Date: ____________________
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HSE Permit Coordinator Responsibilities
• The HSE Permit Coordinator is responsible for daily coordination of the work
permits.
• He is responsible for full clerical control of the system including retention of the
closed out Work Permits for one-week period.
• Has the full overview of the planned, open and suspended work permits on visual
display in his permit to work office.
_________________________________
Signature above printed Name
Date: ____________________
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