ELECTRICAL WORK PERMIT

Project Name: Permit No.:

Date: From: To: Duration (Time): From: To:
1. Details of Work:
1.1 Name of Company:
1.2 Location of Work:
1.3 Description of Work:

1.4 Person in Charge (supervisor): No. of Workers:

1.5 Equipment & Tools
to be used:
Fire Hazard Damaged Insulation Damaged Tools & Equipment

2. Hazard Improper Grounding Trip & Fall Hazard Poor Wiring & Overload Circuits
Considerations
Wet Conditions Electrical Shock Hazard Overhead Power Lines

Additional Hazards to be present: (for further, you may use back side of this page):

Daily/Monthly Inspection of
Fire Extinguisher Avoid Wet Conditions/Areas
Tools/Equipment’s, & Cords
3. Precautions &
Fire Protection Don’t Overload an Outlet & Use
Proper Grounding Repair & Maintenance
Proper Circuit Breakers

Additional Precautions to be taken: (for further, you may use back side of this page):

4. Atmospheric Test: Gas test required? Yes No If yes record the results below
Name Time Flammable 0% LEL Oxygen 23.5%-19.5% H2S Signature

Remarks Regular basic PPE, availability of adequate supervision, method of statement, & risk assessment, etc., are mandatory.
Person Authorized Permit Name Position Sign Date
Permit Receiver from Sub-Contractor:
Permit Issuer from HHI:
Tick Permit Statement Person Name Sign Date
Permit date is finished, job is still not Request (Receiver)
finished, Please extend the date of the Approved (Issuer)
Permit Permit extended up to:
Request (Receiver)
Permit is closed, job is completed
Approved (Issuer)
Permit Cancellation:
Cancellation Remarks:
Cancellation Requested By: Authorized By:

HHI-PTW-02, REV-00