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Ref: IX-HW-BBET-HSE-R9-001Rev0

Honeywell International ME- HBS- Duba


Site-Busi
WORK PERMIT No: Executive Tower
GENARAL WORK PER

Section A TYPE OF PERMIT

COLD HOT

Section B JOB PARTICULARS

Zone: Tower: Floor:

Job Description:

Name of Subcontractor: Supervisor Name:

ITEX

Section C NATURE OF WORK


WORK AT HEIGHT-SCAFFOLDING WORK AT HEIGHT-LADDER BELOW 1.8Mtr.
WORK ON HOT SURFACE MATERIAL LODING/UNLOADING
SPLICING/TERMINATION MANUAL MATERIAL HANDLING
TESTING/COMMISSIONING WORKING WITH ROTATING POWER TOOLS

Section D HAZARD CONSIDERATION


FIRE FALL FROM HEIGHT
NOISE & VIBRATION BIOLOGICAL HAZARDS
CUT ON BODY PARTS CRUSHING
ERGONOMIC DUST/FUMES
TOXIC / CORROSIVE MATERIAL WORKING WITH ELECTRICAL EQUIPMENT
SLIP, TRIP & FALL AT SAME LEVEL DROPPED TOOLS or OBJECT
DAMAGED TO THE PROPERTY POOR ACCESSIBILITY
EXCESS HOT ATMOSPHERE & HUMIDITY HAZARD FROM NEARBY ACTIVITY
SECTION E PREPARATION REQUIRED FOR SAFE EXECUTION
ENTRY RESTRICTED - BARRICADING WARNING BOARDS AT PLACED
ESCAPE ROUTES CHECKED AND CLEAR ADEQUATE SUPERVISION PROVIDED
DRAINAGE, MANHOLES COVERED LOTO ENSURED
NEARBY WORK HAZARD CONSIDERED INSPECTION TAG ON SCAFFOLD

JBR/ARK/HBS/FRM-0001 Rev.02
TBT CONDUCTED and RA DISCUSSED WORK AREA PHOTO TAKEN BEFORE START
MANDATORY PPEs PROVIDED AND USED JOB SPECIFIC PPEs AVAILABLE AND USED

SECTION F AUTHORISATION PERIOD

Permit is authorized from _________Hrs. On Date _______________ up to end of current da


per Section I (see overleaf)
SECTION G APPROVALS
Authority Level Name & Designation Sign

Issuer

Acceptor
SECTION H CLOSURE/ CANCELLATION
Select required box
Permit Closed - Job Completed. Snap taken, all equipment/tools used for job are removed & area clean.

Permit Closed - Job Incomplete. All equipment/tools used for job are removed & area clean.

Permit Cancelled / Rejected - Permit cancelled as present condition are not conducive for carrying the work

JBR/ARK/HBS/FRM-0001 Rev.02
SECTION I EXTENSION/ RENEWAL

DAY DATE VALID FROM VALID UP TO

JBR/ARK/HBS/FRM-0001 Rev.02
JBR/ARK/HBS/FRM-0001 Rev.02
nternational ME- HBS- Dubai
Site-Business Bay
wer
GENARAL WORK PERMIT

WORK ON ELECTRIC EQUIPMENT

Location:

Planned number of persons on the job:

HEIGHT-LADDER BELOW 1.8Mtr. WORK AT HEIGHT-LADDER ABOVE 1.8 Mtr.


L LODING/UNLOADING PAINTING
MATERIAL HANDLING GRINDING/DRILLING
G WITH ROTATING POWER TOOLS HACKSAW CUTTING

UNAUTHORIZED ENTRY
CAL HAZARDS ELECTRIC SHOCK
ELECTRIC ARC FLASH
STORED ENERGY
G WITH ELECTRICAL EQUIPMENT MOVING OBJECT
D TOOLS or OBJECT POOR VISIBILITY
CESSIBILITY WET & SLIPPERY SURFACE
FROM NEARBY ACTIVITY OTHER-

G BOARDS AT PLACED FALL PROTECTION PROVIDED


TE SUPERVISION PROVIDED PROPER LIGHTING PROVIDED
STANDBY PERSON PROVIDED
ON TAG ON SCAFFOLD INSPECTED LADDER. TAG NO-

JBR/ARK/HBS/FRM-0001 Rev.02
REA PHOTO TAKEN BEFORE START INSPECTED ELECTRICAL EQUIPMENT. TAG NO-
IFIC PPEs AVAILABLE AND USED OTHER PRECAUTIONS -

_______ up to end of current day (max up to 1700 Hrs.) Unless extended as


ection I (see overleaf)

Sign Date Time

Name & Sign Date & Time


used for job are removed & area clean. Acceptor

or job are removed & area clean. Acceptor

are not conducive for carrying the work.

JBR/ARK/HBS/FRM-0001 Rev.02
VALID UP TO ISSUER NAME & ID No. ACCEPTOR

JBR/ARK/HBS/FRM-0001 Rev.02
JBR/ARK/HBS/FRM-0001 Rev.02