Safe Work
Work Permits
Permits
1
Safe
Safe Work
Work Permits
Permits
2
Safe
Safe Work
Work Permits
Permits
3
Safe
Safe Work
Work Permits
Permits
Safe
SafeWork
WorkPermit
Permit Permit #
Permit #
Type: (hot work, confined space, line break, etc.... location:
Type: (hot work, confined space, line break, etc.... location:
Valid __/___/___ ____ __/___/___ ____ Issued to:
Valid M
From: __/___/___
D Y ____ to M __/___/___
time D Y ____
time Issued to:
From: M D Y time to M D Y time
Work Description: ________________________________
Work Description:
____________________________________________ ________________________________
Supervisors Signature Print name
____________________________________________
____________________________________________ Supervisors Signature Print name
____________________________________________
____________________________________________ Work Order No.
____________________________________________ Work Order No.
Atm Combustible vapors or gases (<10%) Oxygen Concentration (>19.5% & <21%) Toxic Material Concentration
Atm Combustible vapors or gases (<10%)
Tests Oxygen Concentration (>19.5% & <21%) Toxic Material Concentration
Tests
Precautions Always Required:
Precautions Always Required:
4
Safe
Safe Work
Work Permits
Permits
and collapse of excavation walls and piles due to poorly secured soil, sudden
weather changes, or other factors.
7
Safe
Safe Work
Work Permits
Permits
Excavations may expose hazardous materials, which have leaked and are
contaminating the soil.
9
Safe
Safe Work
Work Permits
Permits
Internal combustion engines produce poisonous
gases
such as ensure
Permits carbon that
monoxide, and oxides
procedures of nitrogen.
are followed that will prevent
equipment emissions from contaminating air inside buildings
and confined spaces.
10
Safe
Safe Work
Work Permits
Permits
Unauthorized use of company
equipment can result in lost
production and injury to untrained
operators.
11
Safe
Safe Work
Work Permits
Permits
Work which ordinarily does not require safe work
permits may be included at the discretion of the
Safety Representative, the Contractor, or the Contract
Administrator.
12
Safe
Safe Work
Work Permits
Permits
Following are examples of situations which may require
discretionary safe work permits.
13
Safe
Safe Work
Work Permits
Permits
Movement of
large pieces of equipment,
especially while other personnel
are working nearby, can result
in employee injury.
Permits may be issued to ensure
the use of procedures that will
prevent employee injury from
falling material, or being struck
by rigging equipment.
14
Safe
Safe Work
Work Permits
Permits
Abandoned tanks, pipe lines,
drums, and vessels may contain
hazardous vapors and gases.
Permits may be issued to prevent
toxic or corrosive exposures to workers
when working on abandoned
equipment,complementing hot work
and confined space permits.
15
Safe
Safe Work
Work Permits
Permits
17
Safe
Safe Work
Work Permits
Permits
Permits may be required
where the consequence
of noncompliance with
fall protection requirements
is severe, or where dropped
materials may endanger
other workers below.
18
Safe
Safe Work
Work Permits
Permits
19
Safe
Safe Work
Work Permits
Permits
CAUTION
Hazardous Materials!
Safe Work Permit Required!
20
Safe
Safe Work
Work Permits
Permits
Safe
SafeWork
WorkPermit
Permit Permit #
Permit #
Type: (hot work, confined space, line break, etc.... location:
Type: (hot work, confined space, line break, etc.... location:
Valid __/___/___ ____ __/___/___ ____ Issued to:
Valid M
From: __/___/___
D Y ____ to M __/___/___
time D Y ____
time Issued to:
From: M D Y time to M D Y time
Work Description: ________________________________
Work Description:
____________________________________________ ________________________________
Supervisors Signature Print name
____________________________________________
____________________________________________ Supervisors Signature Print name
____________________________________________
____________________________________________ Work Order No.
____________________________________________ Work Order No.
21
Safe
Safe Work
Work Permits
Permits
Safe
SafeWork
WorkPermit
Permit Permit #
Permit #
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
Work Description: ________________________________
Work Description:
____________________________________________ ________________________________
Supervisors Signature Print name
____________________________________________
____________________________________________ Supervisors Signature Print name
____________________________________________
____________________________________________ Work Order No.
____________________________________________ Work Order No.
Atm. Combustible Vapors or gases (<10%) Oxygen Concentration ( >19.5% & < 21%) Toxic Material Concentration
Atm. Combustible Vapors or gases (<10%) Oxygen Concentration ( >19.5% & < 21%) Toxic Material Concentration
Tests
Tests
Permit Issued by: _________________________/____/___ Work Area Manager Approval _______________/___/__
Permit Issued by: _________________________/____/___ Work Area Manager Approval _______________/___/__
22
Safe
Safe Work
Work Permits
Permits
Safe
SafeWork
WorkPermit
Permit
----------------------------------------------------------------------
----------------------------------------------------------------------
Precautions
PrecautionsAlways
Alwaysrequired:
required:
oo Emergency
Emergencyprocedures
proceduresreview
reviewby:
by:
oo Emergency
Emergencyequipment
equipment&&location
locationreview
reviewby:
by:
o Area inherent hazards review by:
o Area inherent hazards review by:
oo Material
MaterialSafety
SafetyData
DataSheet(s)
Sheet(s)review
reviewby:
by:
23
Safe
Safe Work
Work Permits
Permits
Safe
SafeWork
WorkPermit
Permit
----------------------------------------------------------------------
----------------------------------------------------------------------
Special
SpecialPrecautions
PrecautionsRequired:
Required:
o Buddy System o Sprinklers in Service
Required special precautions
o Buddy System o Sprinklers in Service
oo Cleaning
Cleaningofof_________
_________ oo Purging
Purgingofof________
________ must be clearly indicated and
oo Remove materials from ___________________
Remove materials from ___________________
oo Piping
Piping ooDrain
Drain oo Disconnect
Disconnect ooBlank Blankoffoff/ /Capped
Capped
communicated to workers,
oo Clean o Ventilate
Clean o Ventilate
oo Remove
and their supervision.
Removecombustibles
combustiblesfrom fromother
otherside
sideofofwall.
wall.
oo Floor Swept Clean of Combustibles
Floor Swept Clean of Combustibles
o Clean area within 35 feet. o Wet down floor. It is the safety representatives
o Clean area within 35 feet. o Wet down floor.
ooAdjacent
Adjacentareas:
oo Cover
areas: __________________________
floor with:
__________________________
__________________________
responsibility to determine if
Cover floor with: __________________________
oo Non-combustible
Non-combustibleTarpaulins
TarpaulinsororMetal
MetalShields
ShieldsOver:
Over: and when special measures
oo Electrical
Electrical Switches or Valves off, locked-out, andTagged:
Switches or Valves off, locked-out, and
oo Electrical Grounding of: ________________________
Tagged: are required.
Electrical Grounding of: ________________________
ooAtmosphere
Atmospheremonitored
monitoredduring
duringwork
workfor:
for:____________
____________
periodically: __________ continuously: __________
periodically: __________ continuously: __________
oo Safety
SafetyMonitor(s)
Monitor(s)present
presentfrom
from_________
_________toto_________
_________
oo Fire
Fire Watch Present during work and for 30 minutesafter...
Watch Present during work and for 30 minutes after...
oo Respirator to be worn____ or be readily available ___
Respirator to be worn____ or be readily available ___
24
Safe
Safe Work
Work Permits
Permits
Safe
SafeWork
WorkPermit
Permit
----------------------------------------------------------------------
----------------------------------------------------------------------
Safety
SafetyEquipment
EquipmentRequired
Required
o safety glasses
o safety glasses
o hard hat
o hard hat
Personal protective equipment
o face shield
o face shield
o safety shoes
o safety shoes
and other safety equipment required
o fire extinguishers - type ___ #___ size ___
o fire extinguishers - type ___ #___ size ___
o fire hose
o fire hose
is specified.
o supplementary illumination
o supplementary illumination
o warning signs
o warning signs
o barricades
o barricades
o non-sparking tools
For each hazard present at the work
o non-sparking tools
o explosion proof equipment
o explosion proof equipment
o safety harness
site, the safety representative must
o safety harness
o life line
o life line
o tripod emergency escape unit
specify a hazard control.
o tripod emergency escape unit
o 2-way radio or phone
o 2-way radio or phone
o respirators
o respirators
o impervious gloves
o impervious gloves
o protective clothing _____________________
o protective clothing _____________________
o mechanical ventilation
o mechanical ventilation
o shower & eyewash
o shower & eyewash
o self contained breathing apparatus
o self contained breathing apparatus
o ground fault circuit interrupter
o ground fault circuit interrupter
o ladder / lift / scaffold
o ladder / lift / scaffold
o other________________________________
o other________________________________
25
Safe
Safe Work
Work Permits
Permits
The safety representative must verify
that all underground utilities have
been located and staked out.
26
Safe
Safe Work
Work Permits
Permits -- SUMMARY
SUMMARY
- Hot work, confined space entry, excavations, blasting,
use of internal combustion engines inside of buildings,
use of company owned or leased equipment, and areas where
Safe Work Permit Required signs are posted always require
a safe work permit.
27