Permit To Work
The permit to work helps to reduce the risk of safety incidents by ensuring the people involved are aware of the specific hazards, take the necessary precautions and are competent for the work.
Groeneveld-Beka
08/22/2022
Permit To Work
The permit to work helps to reduce the risk of safety incidents by ensuring the people involved are aware of the specific hazards, take the necessary precautions and are competent for the work.
1) Who is conducting the task?
2) What task is being done?
3) Date issued:
4) Location of task:
5) Risk assessment received?
6) Method statement received?
7) Checked by (Print Name):
8) Checked by (Signature):
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9) Describe activity (equipment, installation, safety procedures):
10) Specific Hazards:
11) Precautionary Measures:
12) Essential Personal Protective Equipment (PPE):
13) GV Site Induction Completed:
14) Contractor will work to their supplied RAMS:
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15) Validity period of Permit (START DATE):
15.1) Validity period of Permit (FINISH DATE):
16) Contractor (Company Name & Address):
17) Groeneveld Authorising Person (Print Name):
18) Groeneveld Authorising Person (Signature):
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19) Agreed Task & Section Acceptance (Print Name):
20) Agreed Task & Section Acceptance (Signature):
21) Waste disposal actions must be confirmed before leaving: site
22) Environmental compliance control of waste:
23) Precautionary Measures Checked by (Print Name):
24) Precautionary Measures Checked by (Signature):
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25) Precautionary Measures Checked by (Date):
26) Re-commissioning of equipment or processes and any necessary safety testing has been carried out (Print Name):
27) Re-commissioning of equipment or processes and any necessary safety testing has been carried out (Signature):
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27) Re-commissioning of equipment or processes and any necessary safety testing has been carried out (Date):
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Source: Groeneveld-Beka (Community Member)