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Name of Project : PRIORITY WORKS (STREET LIGHTING, STORM WATER DRAINAGE AND KERBS) SOUTH EAST SEC
Work location :
Pemi
Permit Validation
From
Date:
Time :
Expire
Da
Tim
Description of Work :
Hazard Identied
Special Precautions
Permit is valid only if the conditions existing at the time of issuance continue. It expires upon occurrence(s) gas leak, liqu
Safety Measures
YES
No
N/A
Has the work area been inspected and reasonable precaution taken to ensure that no potential
hazards exist?
Necessary barricades, warning signs in place in the area
Workers been inducted and safety oriented to the job being perform.
TBT held prior to start the work.
Necessary Personal Protective equipments provided to the workers.
Flagmen / banksmen assigned to control the traffic
I understand and agree that no work is permitted other than that specified on this permit. I have check both permit and the job, and understand
work and precaution to be followed in completing the work
Engineer / Supervisor/
Signature :
Date :
Signature :
Date :
Signature :
Date :
Asphalt foreman
Checked by:
Safety Officer
Issued by:
Project Engineer
Signature :
Date :
Signature :
Date :
Revision 0
AGP/HSE/SF/045
Revision 0
Signature :
Date :
AGP/HSE/SF/045
N/A
Remarks
Time :
Time :
Time :
Time :
Revision 0
AGP/HSE/SF/045
Time :
Revision 0
AGP/HSE/SF/045