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Permit To Work: PTW N° | PDF | Equipment | Occupational Safety And Health
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Permit To Work: PTW N°

This permit to work document outlines safety requirements for a work activity. It requires identification of work description, risks, required personal protective equipment, isolation precautions, safety preventative measures, gas monitoring as needed, number of workers required, and signatures authorizing the work. The permit is valid only for the specified duration and location, and inspections are needed if work extends beyond one shift. The permit must be properly closed out once work is complete.

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Rachid Zgrh
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236 views2 pages

Permit To Work: PTW N°

This permit to work document outlines safety requirements for a work activity. It requires identification of work description, risks, required personal protective equipment, isolation precautions, safety preventative measures, gas monitoring as needed, number of workers required, and signatures authorizing the work. The permit is valid only for the specified duration and location, and inspections are needed if work extends beyond one shift. The permit must be properly closed out once work is complete.

Uploaded by

Rachid Zgrh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HSE

PERMIT TO WORK
Code: FR_HSE08
Rev 0
Date Dec20

PTW n°………
Date:...../……../……. Work order n°…………… Site:………………………
Work description

Duration of PTW: from…..….…/……...../…..….to:……/…….../……..…


Risk Description

PPE Required CPE required ISOLATION_ IDENTIFICATION & PRECAUTIONS


Safety Glasses Extinguisher Electrical Isolation Mechanical isolation Purging
safety harness Fire Monitor
Safety shoes Scaffold 0 Identification q Injection inert gas q Valve closed q
Gloves Showers Grouding H2S detection Shut down
Masks Fire Blanket
Helmets ADF Tools Safety perimeter O2 measure By pass
Face protection Welding screen
Lock out tagout Additional lighting Certificat/Tests
Safety prevention meausres

Temperature measure leaks

Pressure measur HSE supervisor

Others recommendations:

gas measure :(case of confined space) : O2 : H2S: Inflammable Gas : Toxic Gas :
Number of person required for performing the work : …………………………………….
Performin

Authorit

Signature Performing authority


I'm Informed about risks and safety preventive measures. Date :
g

Authorization to begin the works


Work Supervisor/Permit authoriser HSE supervisor
Name :
Signatures

Name : Date
Signature :
Signature : :
Hour
:
Extension Inspection

comment and actions :

Signature Date from……./………/……to…..…./…………/……….. f…./……/……to…../……/…… f…./……/……to….../………/………


Work supervisor/
Permit authoriser

HSE supervisor

To be signed at the start of each work period. It's safe to continue work and the permit conditions have not change.
Date Permit authoriser Performing authoriser HSE supervisor
Validity

1/-TagOut 3/- Restart in safety condition 0


Closing

2/-work area was clean


Visa Permit authoriser …………………………..
This PTW is not valid any more!!
PT
W
Note1:For the works in confined space , the validity of PTW is 24 Hours .For possible necessity a new PTW must be opened and approuved.
Note

Note2:For electrical work , duration of the PTW must be defined , and PTW is not renewable.
for possible necessity , a new PTW must be done and approuved.

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