Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
WORK PERMIT
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Permit No.:
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Permit Duration:
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Permit Start Date:
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Permit End Date:
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Project:
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Contractor:
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Location:
- Al Maather-Riyadh
- Al Hazem-Riyadh
- Al Waha-Jeddah
- Bawat-Madinah
- Hindawiah-Jeddah
- Al Khatam-Madinah
- Al Lith-Jeddah
- Khuzam-Jeddah
- Murjan-Jeddah
- Mahjar-Jeddah
- Hail-Hail
- Taima-Tabuk
- 69KV-Dammam
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Description of Work
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Activity In charge
- Project Engineer
- Site Engineer
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No. of Manpower:
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Contact No.:
EQUIPMENT USED
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Equipment Used:
- Bobcat/Skid Steer Loader
- Backhoe/Excavator
- Roller Compactor
- Generator
- Crane
- JCB/Backhoe Loader
- Mini Compactor
- Testing Machine
- Dump Truck
- Pay Loader
- Power Tools
- HDD Machine
- Other Equipment
POSSIBLE HAZARDS
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Possible Hazards
- Underground Utilities
- Unguarded Wall and Edges
- Fall/Working at Heights
- Vehicle Movement
- Unsecured Platform
- Unsecured Access/Egress
- Confined/Limited Space
- Falling Objects
- Live OHTL/UGHV Cables
- Load Manual Handling
- Uneven Floors/Surface
- Hot/Wet/Dusty Condition
- Radiation
- Fire
- Chemical
- Sharp object
- Pointed Object
- Noise
- Other Hazards not listed above
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NG Safety Checklist Satisfied?
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Requested by:
- Aju Thomas
- Amal Muraly
- Sindarth Khrisnan
- Michael Dave Herrero
- Darwin Llantada
- Allan Rey Rizalde
- Ryan Cabarlo
- Bryle Cyril Besinga
- Archie Pulmano
- Charlie Villanueva
- Charles Subong
- Bahar Ali Muhammad
- Jaafar Lagayan
- Rainerio Bacon
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Date and Time Requested
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Contractor Safety Representative
- Aju Thomas
- Amal Muraly
- Sindarth Khrisnan
- Michael Dave Herrero
- Darwin Llantada
- Allan Rey Rizalde
- Ryan Cabarlo
- Bryle Cyril Besinga
- Archie Pulmano
- Charlie Villanueva
- Charles Subong
- Bahar Ali Muhammad
- Jaafar Lagayan
- Rainerio Bacon
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Signature of Contractor Safety Representative
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Contractor Project/Site Manager
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Signature of Project/Site Manager
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Note: No attached Checklist-No Approval-No Work
Audit - duplicate
WORK PERMIT
-
Permit No.:
-
Permit Duration:
-
Permit Start Date:
-
Permit End Date:
-
Project:
-
Contractor:
-
Location:
- Al Maather-Riyadh
- Al Hazem-Riyadh
- Al Waha-Jeddah
- Bawat-Madinah
- Hindawiah-Jeddah
- Al Khatam-Madinah
- Al Lith-Jeddah
- Khuzam-Jeddah
- Murjan-Jeddah
- Mahjar-Jeddah
- Hail-Hail
- Taima-Tabuk
- 69KV-Dammam
-
Description of Work
-
Activity In charge
- Project Engineer
- Site Engineer
-
No. of Manpower:
-
Contact No.:
EQUIPMENT USED
-
Equipment Used:
- Bobcat/Skid Steer Loader
- Backhoe/Excavator
- Roller Compactor
- Generator
- Crane
- JCB/Backhoe Loader
- Mini Compactor
- Testing Machine
- Dump Truck
- Pay Loader
- Power Tools
- HDD Machine
- Other Equipment
POSSIBLE HAZARDS
-
Possible Hazards
- Underground Utilities
- Unguarded Wall and Edges
- Fall/Working at Heights
- Vehicle Movement
- Unsecured Platform
- Unsecured Access/Egress
- Confined/Limited Space
- Falling Objects
- Live OHTL/UGHV Cables
- Load Manual Handling
- Uneven Floors/Surface
- Hot/Wet/Dusty Condition
- Radiation
- Fire
- Chemical
- Sharp object
- Pointed Object
- Noise
- Other Hazards not listed above
-
NG Safety Checklist Satisfied?
-
Requested by:
- Aju Thomas
- Amal Muraly
- Sindarth Khrisnan
- Michael Dave Herrero
- Darwin Llantada
- Allan Rey Rizalde
- Ryan Cabarlo
- Bryle Cyril Besinga
- Archie Pulmano
- Charlie Villanueva
- Charles Subong
- Bahar Ali Muhammad
- Jaafar Lagayan
- Rainerio Bacon
-
Date and Time Requested
-
Contractor Safety Representative
- Aju Thomas
- Amal Muraly
- Sindarth Khrisnan
- Michael Dave Herrero
- Darwin Llantada
- Allan Rey Rizalde
- Ryan Cabarlo
- Bryle Cyril Besinga
- Archie Pulmano
- Charlie Villanueva
- Charles Subong
- Bahar Ali Muhammad
- Jaafar Lagayan
- Rainerio Bacon
-
Signature of Contractor Safety Representative
-
Contractor Project/Site Manager
-
Signature of Project/Site Manager
-
Note: No attached Checklist-No Approval-No Work
