Honeywell International ME- HBS- Dubai

Ref:
Site-JBR-CCTV
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WORK PERMIT No:
Section A TYPE OF PERMIT SPECIAL WORK PERMIT
EXCAVATION CUTTING CONFINED SPACE

Section B JOB PARTICULARS

Cluster : Tower: Floor: Location:

Job Description:

Name of Subcontractor: Planned number of pers

Section C NATURE OF WORKK

WORK AT HEIGHT-SCAFFOLDING WORK AT HEIGHT-LADDER PAINTING
WORK ON HOT SURFACE MATERIAL LODING/UNLOADING VEHICLE ENTRY
SPLICING/TERMINATION EXCAVATION GRINDING/DRI
TEST/INSPECTION WORKING WITH ELECTRICAL EQUIPMENT HACKSAW CUT

Section D HAZARD CONSIDERATION

FIRE FALL FROM HEIGHT ELECTRIC SHOC
EXPLOSION PHYSICAL HAZARD ELECTRIC ARC F
NOISE & VIBRATION DUST/FUMES STORED ENERG
TOXIC / CORROSIVE MATERIAL WORKING WITH ELECTRICAL EQUIPMENT STATIC ELECRTI
SLIP, TRIP & FALL AT SAME LEVEL DROPPED TOOLS or OBJECT POOR VISIBILIT
DAMAGED TO THE PROPERTY POOR ACCESSIBILITY WET & SLIPPER
EXCESS HOT ATMOSPHERE & HUMIDITY HAZARD FROM NEARBY ACTIVITY OTHER-
SECTION E PREPARATION REQUIRED FOR SAFE EXECUTION
ESCAPE ROUTES CHECKED AND CLEAR ADEQUATE SUPERVISION PROVIDED PROPER LIGHTI
DRAINAGE, MANHOLES COVERED LOTO ENSURED STANDBY PERSO
NEARBY WORK HAZARD CONSIDERED INSPECTION TAG ON SCAFFOLD INSPECTION TA
TBT CONDUCTED WORK AREA PHOTO TAKEN BEFORE START SPECIAL EQIPM
OTHER PRECAUTIONS -
SECTION F AUTHORISATION PERIOD

Permit is authorized from _________Hrs. On Date _______________ up to _________Hrs. On Date ___

SECTION G APPROVALS
Authority Level Name & Designation Sign Date

Issuer

Approver 1
Approver 2

Acceptor
SECTION H CLOSURE/ CANCELLATION
Select required box
Permit Closed - Job Completed. Snap taken, all equipment/tools used for job are removed & area Acceptor
clean.

Permit Cancelled / Rejected - Permit cancelled as present condition are not conducive for carrying
the work.
 WORK ON ELECTRIC EQUIPMENT

mber of persons on the job:

EHICLE ENTRY
RINDING/DRILLING
ACKSAW CUTTING

ECTRIC SHOCK
ECTRIC ARC FLASH
TORED ENERGY
TATIC ELECRTICITY
OOR VISIBILITY
ET & SLIPPERY SURFACE

ROPER LIGHTING PROVIDED

TANDBY PERSON PROVIDED
SPECTION TAG ON LADDER- TAG NO-
PECIAL EQIPMENT PROVIDED. NAME-

. On Date _______________.

Date Time
Name & Sign Date & Time