IGPTWNWF

• PTW [Number]

• Contractor Company

• Area of Work

• Valid From (Date + Time)

  Date

• Valid Until (Date + Time)

  Date

• Jigsaw Responsible Person

  Select Ian Glaves Tom Rushby Trevor Arthur Charlie Taphouse Josh Moore Paul Clarke Roger Butcher Dave Mason Robert Dodson Jo Quinn

  • Ian Glaves
  • Tom Rushby
  • Trevor Arthur
  • Charlie Taphouse
  • Josh Moore
  • Paul Clarke
  • Roger Butcher
  • Dave Mason
  • Robert Dodson
  • Jo Quinn

• Contractor Responsible Person

• Details of Work

Further Information

• Is the scissor lift to be used (Full WAH Permit not needed)

  Yes

  No

• Do we have a copy of the contractors IPAF 3A certificate

  Yes

  No

• Are there RAMS for this Project ? If not and you are in any doubt whether they are needed contact H&S for advice

  No

  Yes Previously sent

  Yes Hand Delivered

• Discuss with the contractor how the project will be done and how you will mitigate any hazards to ALARP. Has this been Done

  Yes

  No

• Copy to be scanned for H&S Records

• Has the Contractor Induction Agreement been Received / Completed

  Yes

  No

• Are You willing to Sit the Induction now

  Yes

  No

• Please Leave site, do not start work !!

  Drawing

• Equipment to be isolated

  Yes

  No

• Electrical Lock off to be applied

  Yes

  No

• Compressed Air ,Liquid Pipeline, Gas, Fuel to be drained and cleaned

  Yes

  No

• Is nearby equipment safe for work to proceed

  Yes

  No

• Have other departments been informed where necessary

  Yes

  No

• Are barricades, hoarding or cordons required

  Yes

  No

• Are warning notices needed ? if yes they must be posted

  Yes

  No

• Is there adequate access, and Lighting

  Yes

  No

• Do contractors have required PPE, including specialist PPE, Minimum safety shoes and hi-viz vest.

  Yes

  No

• Are other permits live in the area

  Yes

  No

• Will the Jigsaw Representative be on site for periods when the contractor is on site.

  Yes

  No

• Name of Supervising Jigsaw Employee

• Are all laws and regulations complied with

  Yes

  No

• Do you Require any Further advice from H&S Department

  Yes

  No

Further Permits

• Are Further Permits Required

  Yes

  No

• Choose Required Permits From Dropdown List

  Select Hot Work Work at Height Confined Space Fragile Roof High Voltage Excavation

  • Hot Work
  • Work at Height
  • Confined Space
  • Fragile Roof
  • High Voltage
  • Excavation

Work at Height Permit

• The time and date of Work at Height permit is the same as specified on the work permit

• Explain how the work at height will be carried out

• All Persons working at height have been trained and any relevant certification has been provided

  Yes

  No

• All tools will be secured with no potential of them falling from height

  Yes

  No

• What form of work at height will be used

  Select Cherry Picker or Articulated Boom Scaffold Tower Ladders / Step Ladders

  • Cherry Picker or Articulated Boom
  • Scaffold Tower
  • Ladders / Step Ladders

• Has the user Completed an IPAF 3c certified Training Course

  Yes

  No

• Has the certification been seen and a copy stored in the relevant H&S folder

  Yes

  No

• YOU WILL NOT BE ALLOWED TO DRIVE OR OPERATE A MEWP ON THIS SITE

• Is a safety harness required for this task

  Yes

  No

• The user is to inspect the harness and ensure it is in an acceptable condition

  Yes

  No

• PLEASE REPLACE THE HARNESS OR ASK YOUR HOST IF YOU CAN BORROW ONE OF JIGSAW FOODS HARNESS'S

• Has the user completed a PASMA certified training course

  Yes

  No

• Has the certification been seen and a copy stored in the relevant H&S folder

  Yes

  No

• The user is to ensure the scaffold is checked for defects, is built correctly and safely and the scafftag has been completed and correctly displayed (Blank Scafftags are supplied by our H&S manager in unit 1 - contact ext 3142)

  Yes

  No

• YOU WILL NOT BE ALLOWED TO ERECT OR CERTIFY THE SCAFFOLD TOWER - ASK YOUR HOST TO ARRANGE FOR THE TOWER TO BE BUILT FOR YOU AND THE PASMA TRAINED PERSONNEL TO INSRUCT YOU ON THE SAFE USE OF THE TOWER

• Ladders have been checked, are in good condition and are appropriate for this task

  Yes

  No

• DO NOT USE THIS LADDER, YOUR HOST MAY BE ABLE TO ARRANGE FOR YOU TO USE A SET OF OUR ENGINEERS LADDERS

• A second person must be used to stabilise the ladder, this applies to all ladder types, is a second person available

  Yes

  No

• DO NOT ATTEMPT TO USE THE LADDER UNASSISTED, YOUR HOST MAY BE ABLE TO PROVIDE SOMEONE TO ASSIST YOU

Hot Work Permit

• The date of Hot work permit is the same as specified on the work permit

• Explain How the hot work will be carried out

• What time will the hot work start

  Date

• What time will the hot work finish

  Date

• Have Risk assessments been carried out specifically for the work to be done. They are a physical requirement of the permit

  No

  Yes Previously sent

  Yes Hand Delivered

• This Is Required and Hot Work cannot continue without this

• Copy to be scanned for H&S Records

• Flammable / combustible Materials removed ( 6m minimum including other side of metal cladding and walls )

  Yes

  No

• Are fire extinguishers available at the immediate point of working (not just nearby)

  Yes

  No

• Have fire Marshalls been briefed and placed on standby

  Yes

  No

• Have warning notices been posted

  Yes

  No

  N/A

• Have other departments been informed of hot work where necessary

  Yes

  No

  N/A

• Has the area below the work been cordoned off

  Yes

  No

  N/A

• Have Screens been erected to protect others from intense light and UV radiation emitted from welding arc

  Yes

  No

  N/A

• Nearby cable trays and equipment protected from falling sparks

  Yes

  No

  N/A

• Is nearby equipment safe for hot work to proceed

  Yes

  No

  N/A

• has a safe grounding point for arc welding equipment been specified to the contractor

  Yes

  No

  N/A

• Loadcells and other sensitive electronics potentially sharing the same electrical grounding have been switched off or isolated

  Yes

  No

  N/A

• Is Gas cutting torch equipment and cylinders in good condition and adequately secured

  Yes

  No

  N/A

• What Personal Protective Equipment is required :- NB. In case of welding, applicable to welders and their helpers

  Select Full face welding visor Respirators or dust masks suitable for welding fumes welding mitts / gloves

  • Full face welding visor
  • Respirators or dust masks suitable for welding fumes
  • welding mitts / gloves

• Are the persons selected for the job trained in the use of any special safety equipment required

  Yes

  No

  N/A

• Is Adequate ventilation available

  Yes

  No

• Are local regulations / laws complied with

  Yes

  No

• Any other preparations made ( specify )

  Yes

  No

• Please Specify

• Any other hazards to watch for ( Specify )

  Yes

  No

• Please Specify

• Has a fire watch been arranged for at least 1 hour after hot work is completed to ensure that no smoldering objects exist which could flare up later

  Yes

  No

• A FIRE WATCH MUST BE ARRANGED

• Enter Name of Fire Watch

• If Hot work is taking place outside normal working hours have fire marshalls been allocated on overtime for full duration of the work plus a fire watch as per above item

  Yes

  No

  N/A

• Enter name of Fire marshall

Excavation Permit

• The time and date of excavation permit is the same as specified on the work permit

• Explain how the excavation work will be carried out

• Have Risk assessments been carried out specifically for the work to be done. They are a physical requirement of the permit

  No

  Yes Previously sent

  Yes Hand Delivered

• DO NOT ALLOW WORK TO START WORK UNTIL THE RELEVENT RISK ASSESSMENTS HAVE BEEN COMPLETED AND SUBMITTED

• Copy to be scanned for H&S Records

  Yes

  No

• Have all underground electric cables, gas pipes, water pipes, sewage pipes and other services been identified before hand

  Yes

  No

• THESE SERVICES MUST BE IDENTIFIED BEFORE THE WORK CONTINUES

• Ensure Proof of This, eg: site blue prints have been seen / discussed between Jigsaw Foods and the contractor

• Is detection equipment to detect cables and metal pipes available

  Yes

  No

  N/A

• Has digging by hand been arranged for near the depth of such services and below

  Yes

  No

  N/A

• Have ground conditions been assessed

  Yes

  No

  N/A

• Have the sides of the excavation to be shored and braced (required if depth >1.5m)

  Yes

  No

• Is there adequate access and egress

  Yes

  No

• Have Ladders been Secured and checked

  Yes

  No

  N/A

• Are there handrails or other form of edge restraint to prevent people or vehicals falling in

  Yes

  No

• Have vehicals been restricted from driving closer than 3m from the sides of the excavation

  Yes

  No

  N/A

• Have warning notices been posted

  Yes

  No

  N/A

• Has provision been made for drinage of rainwater and groundwater

  Yes

  No

  N/A

• Has provision been made for safe temporary storage or approved disposal of spoils

  Yes

  No

  N/A

• Are the sides monitored for signs of ground movement

  Yes

  No

• Is a daily inspection of the excavation recorded on a logsheet

  Yes

  No

• Are local regulations / laws complied with

  Yes

  No

  N/A

• Have other preperations made

  Yes

  No

  N/A

• Specify other preperations

• Are There any other hazard to watch for

  Yes

  No

  N/A

• Specify other Hazards

High Voltage Permit

• The time and date of High voltage permit is the same as specified on the work permit

• Explain how the high voltage work will be carried out

• Have Risk assessments been carried out specifically for the work to be done. They are a physical requirement of the permit

  No

  Yes Previously sent

  Yes Hand Delivered

• This Is Required and high voltage Work cannot continue without this

• Copy to be scanned for H&S Records

• Flammable / combustible Materials removed ( 6m minimum including other side of metal cladding and walls )

  Yes

  No

• Are fire extinguishers available at the immediate point of working (not just nearby)

  Yes

  No

• Have fire Marshalls been briefed and placed on standby

  Yes

  No

• Have warning notices been posted

  Yes

  No

  N/A

• Have other departments been informed where necessary

  Yes

  No

  N/A

• Has the area been cordoned off

  Yes

  No

  N/A

• Have electrics been isolated and locked off where possible

  Yes

  No

  N/A

• Nearby cables in good codition and do not present a trip hazard

  Yes

  No

  N/A

• is nearby equipment safe for work to proceed

  Yes

  No

• is the area dry and free from chemical substances

  Yes

  No

• Loadcells and other sensitive electronics potentially sharing the same electrical grounding been switched off or isolated

  Yes

  No

  N/A

• Are voltage meters in good working condition and correctly rated for the current

  Yes

  No

• What personal protective equipment is required (specify)

• Are the persons selected for the job trained in the use of any special safety equipment required

  Yes

  No

  N/A

• Is adequate ventilation available

  Yes

  No

• Are all regulations / laws complied with

  Yes

  No

• Any other preperations made

  Yes

  No

• Please state

• Any other hazards to watch for

  Yes

  No

• Please state

Confined Space Permit

• The time and date of confined space permit is the same as specified on the work permit

• Explain how the confined space work will be carried out

• Have Risk assessments been carried out specifically for the work to be done. They are a physical requirement of the permit

  No

  Yes Previously sent

  Yes Hand Delivered

• This Is Required and confined space work cannot continue without this

• Copy to be scanned for H&S Records

• is the area resticted to entry of materials such as liquids or solids that may result in a person drowning or causing asphyxiation

  Yes

  No

• Have all line connections been isolated by removal / blanking and has electrical equipment been isolated and locked off

  Yes

  No

• Has equipment been properly drained / cleaned, isolated for entry of liquids or other materials

  Yes

  No

• Have arrangements been made for sufficient ventilation

  Yes

  No

• Has Oxygen test been carried out

  Yes

  No

• Give result of test

• Do hot conditions exist that could lead to dangerous increase in body temperature

  Yes

  No

• Limit exposure measures should be put in place

• Has the area been checked for flammable materials or tested for toxic fumes, explosimeter

  Yes

  No

• Is adequate fire fighting equipment available

  Yes

  No

• Is nearby equipment safe for work to proceed

  Yes

  No

• Have other departments been informed where necessary

  Yes

  No

  N/A

• What PPE is required for the task (specify)

• Is breathing appauratus required

  Yes

  No

• Is specialised equipment required

  Yes

  No

• Is there a safety rescue plan in place

  Yes

  No

• Bosun's chair, safety harness, or other access devices in use

• Are the persons selected for the job trained in the use of the special safety equipment required

  Yes

  No

• Name of appointed standby person (buddy) , to watch for the safety of the person carrying out the work

• Is adequate lighting available

  Yes

  No

• Are local regulations / Laws complied with

  Yes

  No

• Have any other preparations made

  Yes

  No

• State other prearations made

• Are there any other hazards to watch for

  Yes

  No

• State other Hazards

Fragile Roof Permit

• The time and date of fragile roof permit is the same as specified on the work permit

• Explain how the fragile roof work will be carried out

• Have Risk assessments been carried out specifically for the work to be done. They are a physical requirement of the permit

  No

  Yes Previously sent

  Yes Hand Delivered

• This Is Required and fragile roof work cannot continue without this

• Copy to be scanned for H&S Records

• Is there adequate access

  Yes

  No

• Have Ladders been correctly secured and checked

  Yes

  No

  N/A

• Are there handrails or other forms of edge restraint to stop people falling

  Yes

  No

• Is scaffolding being used

  Yes

  No

• Has the Scaffolding been checked

  Yes

  No

• Are working areas equipped with full-area floorboards

  Yes

  No

• Are there fragile roof areas, ( asbestos, corroded sheeting, overpainted glass, rooflights etc.)

  Yes

  No

• Are barricades or hoarding required

  Yes

  No

  N/A

• Have warning notices been posted

  Yes

  No

  N/A

• Has the area below the work been cordoned off

  Yes

  No

• is nearby equipment safe for work to proceed

  Yes

  No

• Have other departments been informed where necessary

  Yes

  No

  N/A

• What PPE is required ( specify )

• A safety harness is to be worn at all time has this been checked

  Yes

  No

• Is a Bosun chair to be used

  Yes

  No

  N/A

• Are the persons selected for the job trained in the use of any special safety equipment required

  Yes

  No

  N/A

• Name of appointed standby person (buddy) , to watch for the safety of the person carrying out the work

• Is adequate lighting available

  Yes

  No

• Are local regulations / laws being complied with

  Yes

  No

• Have any other preparations been made

  Yes

  No

• List any other preparations

• Are there any other hazards to watch for

  Yes

  No

• List other hazards

Jigsaw Foods Responsible Person sign as all information correct and sign over to contractor

• Jigsaw Foods Responsible Person Name / Signature

  Sign

• Contractor / Engineer Name / Signature

  Sign

Sign Off - Work complete and area left in a safe and tidy condition - Checked by Jigsaw Foods responsible person

• Jigsaw Foods Responsible Person Name / Signature

  Sign