Permit to Work (PTW)– Night Work

Permit No. Date

Project Contractor
Location
Job Description

A. To be filled by the person taking the permit:

Area supervisor Name (Shift Incharge) and Mobile number:

Permit required from : _________hrs._____________ (Date) to _________hrs._____________ (Date)

No. of persons working : ___________

Emergency Vehicle No : _______________________ Driver Mobile: -_____________________

Safety Person : ________________________Mobile: -__________________________
Electrician Name : ________________________Mobile: -__________________________
______________________________________________________________________________
B. Description of the work to be carried out:

______________________________________________________________________________
C. Safety precautions proposed while carrying out the activity:
(This additional information may be added if needed& use additional sheet if required)
1.
2.
3.

D. Others:
Additional safety precautions to be taken with respect to working at night as applicable (if any)
1.
2.
3.

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 Permit to Work (PTW)– Night Work

E. Permit Initiation & Issue:

Declaration of Contractor:
a. All the above safety precautions have been put in place based on Job safety analysis provided
by my organization and verified by me on ground personally.
b. I shall ensure all the necessary precautions are in place till end of the work & I shall take full
responsibility in case of any deviations or lapses noticed on site.
Permit Initiator
(Contractor PM / Engineer)
Checked & Confirmed By
(Contractor Safety Officer)
Comments by PM/CM The contractor is expected to undertake work at site as per their
Safety Precautions and Job Safety Analysis. In case of any Non-
Conformance (NC) to the above noticed by PM/CM/ Consultant/Client
during site rounds, necessary actions as per Contract/Statutory
conditions shall be recommended to Client.

F. Permit Closure

The above-mentioned job has been completed satisfactorily. Date…………………………………. & Time
……………………………… this permit is closed.

Details Name Signature, Date & Time

The work has been completed and can be closed

Permit Initiator
(Contractor PM / Engineer)
Checked & Confirmed By
(Contractor Safety Officer)
Comments by Contractor if
any

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