• Scope of works

  • Permit valid from

  • Permit valid to

Potential Hazards and Controls

  • Depressurizing

  • Draining

  • Adequate lighting

  • Safety tags and locks

  • Electrical isolation

  • Mechanical isolation

  • Exposure to moving/rotating machinery

  • Confined space

  • Fall protection

  • Standby man

  • Ventilate properly

  • Warning notice

  • Potential flammable/explosive atmosphere

  • Potential high temperature

  • Potential high pressure

  • Potential exposure to hazardous materials

  • Excavation works

Personnel Protective Equipment

  • Select PPE to be used

  • Other PPE

Work Authorization

  • Full Name and Signature of Issuer

  • Full Name and Signature of Performer

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