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___________________________________________
Name of the Project: ___________________
Contract No
Permit No_____
_________________________
Age
Trade
No
Skilled/
Unskilled
1
2
3
4
5
6
7
8
9
10
Have been permitted to carry out the:
Nature of work ___________________________________________________________
________________________________________________________________
At (Location) _________________________on (Date) ______________
Mr.___________________________________ will be In-charge/Supervisor of
the Operations and has been instructed to ensure that all the Safety
Precautions as mentioned overleaf are strictly adhered to.
Date
Day 1
Start
Time
Signature of Al-Ojaimi
Safety Officer
Finish
Time
Signature of Consultant
Remarks
___________________________________________
Day
Day
Day
Day
Day
Day
2
3
4
5
6
7
SAFETY INSTRUCTIONS:
Before commencing the work, Engineer/Supervisor/Persons In-Charge of the
work must ensure that the following points are compiled as per the Work
Instructions related to Height Works:
S.No.
Safety Instructions
Compliant Non-Compliant
___________________________________________
10 Sign boards indicating height work, men at work, slow
speed, directions, etc. are to be sufficiently installed.
11 Safety Nets are provided throughout the periphery in two
levels
12 Sufficient illumination has been provided in case of night
works
13 Sufficient care has been taken to ensure that no
electrical wires are near the working area
14 An electrical supervisor or engineer is present while any
work near electrical work is in progress
15 The flat form is clear of loose material or any
hand tool so as to avoid falling on any person
below it?
The above work has been completed satisfactorily by taking all the necessary
safety precautions.
Closure of Work Permit (Date):________