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STARWOOD HOTELS AND RESORTS

PERMIT TO WORK - HOTEL PREMISES


YOUR ATTENTION IS SPECIFICALLY DRAWN TO THE RULES AND
SAFETY PRECAUTIONS CONTAINED ON THIS PERMIT
1. ISSUED TO: __________________________________ ISSUE DATE: _________________

COMPANY NAME: __________________________________ ISSUE DATE: _________________

2. WORK AREA: ________________________________________________________________

3. DESCRIPTION OF WORK: __________________________________________________________

4. DOES THE WORK INVOLVE: YES NO


If YES the appropriate a) HOT WORK
PERMIT TO WORK
must be issued b) ELECTRICAL WORK

c) HIGH LEVEL WORK.

d) LONE WORKING.

e) CONFINED SPACE WORK

5. HAS THE FOLLOWING DOCUMENTATION BEEN RECEIVED AND APPROVED:


YES NO YES NO
a) METHOD STATEMENT c) RISK ASSESSMENT

b) DRAWINGS d) INSURANCE DOCUMENTS.

6. SAFETY PRECAUTIONS REQUIRED: YES NO PPE TO BE WORN: YES NO

BARRIERS ERECTED SAFETY FOOTWEAR

NOTICES POSTED HARD HAT

LADDERS TIED/FOOTED EYE PROTECTION

VENTILATE AREA GLOVES

OTHERS __________________________________________ EAR DEFENDERS

__________________________________________________ OTHERS ____________________________________________

7. AUTHORISATION

This permit authorizes the above to proceed with the work in the area and on the equipment as specified.

SIGNED : (STARWOOD Responsible Person)


8. RECEIPT

I accept responsibility for work on the apparatus, in the area specified in this Permit. I have read and agree to
comply with the specified precautions Starwood Minimum Standards Document for contractors. No attempt
will be made by myself, or anyone under my control, to work on any other apparatus, or in another area,
without prior authorisation.

TO BE SIGNED BY SUB-CONTRACTOR:
9. CESSATION OF WORK (to be signed by Sub-contractor)

This is to certify that the work specified in this Permit has been suspended/completed, and that all men under my
control have been withdrawn. The area/apparatus specified in this Permit has been left clear and in a safe
condition.

SIGNED : TIME AM/PM


10. CANCELLATION (to be signed by responsible person)

I hereby declare this Permit to Work cancelled and that all precautionary measures specified have been
withdrawn.
SIGNED: DATE: TIME AM/PM

TO BE RETAINED BY SUB-CONTRACTOR UNTIL COMPLETION OF THE WORK OR THE END OF THE DAY
WHICHEVER IS EARLIER.