Title Page
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Site conducted
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Date the task is taking place? (Permit is valid for 24hrs)
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Prepared by
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Location
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What is the task? (Brief description of the work taking place).
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What is the name of the contractor?
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Is the contractor performing the task approved on the suppliers database
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Address issue with purchasing department
- Issue addressed with purchasing dept
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Name of the site workgroup manager/supervisor?
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What is the site workgroup manager/supervisors telephone number?
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All members of the workgroup site inducted?
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Perform Contractor Induction and retain evidence.
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Is the worker(s) Gas Safe or similar qualified? Have all related licences/skills cards been witnessed, in date and evidence taken?
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What evidence do they have to show they are competent to perform the task?
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Risk Assessment/Method Statement received and approved?
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Review risk assessment and ensure all precautions stated are in place before work commences.
- Confirmed adherence to the rule
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Has a cooling off period been factored into the risk assessment
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Cooling off period stated in the risk assessment.
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A cooling off period must be adhered to at the end of the work day/task. This is to allow equipment and work/process materials to cool. Any items smoldering can also be detected and extinguished . The during of the cooling off period will be featured within the risk assessment provided by the supplier. Return the risk assessment back to the supplier for revision if this feature is missing.
Significant Hazards and Control Measures . (See Risk Assessment and Method Statement for full details)
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Type of hot work
- Blow lamps
- Brazing
- Cutting
- Grinding
- Soldering
- Welding
- Other Sources of heat generation
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Hazards
- Arc Eye/Welders Flash
- Explosive potential of work
- Fire in immediate area + Spread Potential
- Lone Working
- Other (Please detail)
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Precautions
- Area damp down needed?
- Cooling off period? (Approx 30mins after task)
- Trained fire watchers
- Correct fire extinguishers
- Caution notices/Barriers
- Additional PPE to be worn
- Other (Please detail)
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Are you using any electrical extension leads?
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If using extension leads, you MUST not overload any units, have extensions fed from extensions (Daisy Chaining) and any cabling on spools must be fully wound out to prevent overheating.
- Confirmed adherence to the rule
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Does the task involve working at height or with electrics?
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You must complete additional permits
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Do you require any PPE in addition to site minimum of Hi Viz and Safety Footwear?
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List additional PPE required (As detailed in your Risk Assessment/Method Statement)
What are your First Aid Arrangements
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Who is to assist you in the event of a First Aid Incident
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Have the First Aid team been made aware of your work on site?
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First aid team notified
Emergency Preparedness
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In the event of a fire, is extinguisher/chemical run off into water courses/drains a possibility?
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Emergency spill kit and trained staff needed
Waste Disposal
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Are you generating wastes as part of your task?
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How are you disposing of the waste?
- Schenker's waste arrangement (Segregation required)
- Own arrangement (Advise waste carrier's name)
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Name of waste carrier arranged to collect waste
Authorisation and Acceptance for task to commence
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On behalf of my company, I authorise the work to be undertaken having personally examined the work site and all the documentation and confirm the precautions taken are adequate and conform to the company QSHE Policy
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Issued by :
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Authorised Signature
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On behalf of Contractor Supervisor/Manager, I have personally examined the work location and have read and understood this from.
I undertake to ensure that all works are carried out in accordance with this permit and my own Risk Assessment and Method Statement. -
Issued To:
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Authorised Signature
End of Day. Worksite safe handover declaration
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Has a cooling off period at the end of the day been fulfilled?
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A cooling off period in accordance with the provided risk assessment must be adhered to at the end of the work day/task.
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Work progressing to satisfaction, as per the job order. All work materials, wastes and equipment have been removed (Or made safe). Site services have been restored (if work complete). The area is safe to recommence normal working activities.
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State issues.
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Confirmed by Contractor
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Authorised Signature
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Witnessed by
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Authorised Signature
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Date and Time of sign off
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Any final remarks/Comments?
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Your remarks
Job Completion Declaration
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Task complete?
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Return to End of day worksite safe handover declaration section.
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Has a cooling off period at the end of the day/job been fulfilled?
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A cooling off period in accordance with the provided risk assessment must be adhered to at the end of the work day/task.
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Work progressing or Work completed to satisfaction, as per the job order. All work materials, wastes and equipment have been removed (Or made safe). Site services have been restored (if work complete). The area is safe to recommence normal working activities.
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Confirmed by Contractor
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Authorised Signature
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Witnessed by (Schenker)
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Authorised Signature
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Date and Time of sign off
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Any final remarks/Comments?
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Your remarks
