Binn Group - Permit to Work

• Conducted on

  Date

• Prepared by

• Location
  Address

• Site

• Work Area (If off-site please include the full address)

• Description of Work:

• Work to be performed by:

  Binn Group Personnel

  Contractor

• Name of Contractor

• Method Statemets/ Risk Assessment provided by:

  Contractor

  Binn

  Risk Assessment

Isolations

• Electrical

  Yes

  No

  N/A

• Mechanical

  Yes

  No

  N/A

• Pneumatic

  Yes

  No

  N/A

• Hydaulic

  Yes

  No

  N/A

• Isolation Method:

• Signed:

  Sign

• Job Title of the above signee:

• Lock/Tag No(s)

• In Lock Register

  Yes

  No

  N/A

Hazard Involved

• undefined

  Select Electrical Scaffolding Excavation Hot Work Confined Space Entry Lifting Equipment Work at Height Toxic Chemicals Others/Please Specify

  • Electrical
  • Scaffolding
  • Excavation
  • Hot Work
  • Confined Space Entry
  • Lifting Equipment
  • Work at Height
  • Toxic Chemicals
  • Others/Please Specify

• If you answered others to the above - please specify the hazard below.

• Tools and Equipment to be used for work described

• Control Methods to be employed (Including additional PPE)

• GAS TEST MUST be completed for confined space/ entry work including excavations

• To be considered for hot work

• Gas Test Required

  Oxygen

  Flammable

  Toxic

  Other (Specify)

  None required

• If a gas test was conducted please enter the Gas Levels Detected below

• Confined Space Entry Kit Used:

  Select Gas Test (Mandatory) Full Harness Safety Line Continous Monitoring (Mandatory) Standby Man/Person (Mandatory) 10min escape set No confinded space working required - none applicable.

  • Gas Test (Mandatory)
  • Full Harness
  • Safety Line
  • Continous Monitoring (Mandatory)
  • Standby Man/Person (Mandatory)
  • 10min escape set
  • No confinded space working required - none applicable.

Opening Permit

• Binn Group Issuing Authority - I have inspected this equipment/work area and declare that all control mechanisms are in place and tha it is safe for the work specified in this permit to be carried out.

• Print Name:

  Sign

• Select date

  Date

• PERSON IN CHARGE OF WORK/ RESPONSIBLE PERSON I have read and understood the above conditions and precautions and accept responsibility for carrying out the work detailed in this permit. If conditions change I will contact The Binn Group before deviating from the terms of this permit. I will notify the Binn Group upon completion of the work.

• Print Name:

  Sign

• Persons on Job - Sign On

Closing Permit

• BINN GROUP ISSUING AUTHORITY I declare that all work has been completed / suspended and that all equipment and materials have been removed. The area and equipment affected by the work area has been left in a safe and clean condition.

• Print Name:

  Sign

• Select date

  Date

• PERSON IN CHANRGE OF WORK / RESPONSIBLE PERSON I have checked over the work area and confirm that the work has been completed / suspended and that the above stated conditions prevail. All isolations will be removed when work completed an appropriate authorities will be contacted prior to re-energising and systems affected by this permit.

• THIS PERMIT IS CANCELLED/SUSPENDED

• Print Name:

  Sign

• Persons On Job - Sign Off

• FOR ALL EXTENSIONS A NEW PERMIT TO WORK MUST BE ISSUED.