applicant
EHS CHECKLISTS AND FORMS
PARENT WORK PERMIT

Image   

Permit No (Autofill by Form No.)   

Sub Permit No.
Refer to respective Appendix
Valid for 7 days from the date & time specified. Sketch and checklist to be attached where applicable
Part 1A
Application – to be submitted by 1st Tier Sub-Contractor PM / CM
Work Performed by (Autofill by Company Name)

Name of PM / CM   

Contact No.   

Location & description of work activity (Attach Layout plan)

Use Appendix-A

Use Appendix-B (Job requires Lock Out Tag Out (LOTO) & add-on job)

Work requires Lock Out Tag Out?

 YES
 NO

If yes, state number of work processes that requires LOTO
(Please use appendix-B for the task requires LOTO)
To facilitate LOTO do you required to;

1. Work at height (WAH)

 YES
 NO

2. Enter into confined space

 YES
 NO

If yes, (Please highlight in appendix-A and apply separate sub-permit for WAH and/or confined space entry permit to facilitate LOTO)
Date & Time of Work

From    

To         

No. of Person    

Type of Permit-to-work (PTW) / Checklist (select only one unless the work process requires > 1 PTW)

Work at height (>2m)

Excavation work(>1.5 m)

Lifting operation

Hot work

Confined Space Work

Piling work

Tunnelling work

Demolition Work

Works Above Clean Room Ceiling

Floor opening / Raised Floor/ Barricade Removal Checklist

PM/CM Name     

PM/CM Sign        

Date & Time         

Note; A copy of this approved Parent Work Permit to be displayed in specified location throughout the duration of work. Individual permit shall be displayed at the work location
Prepared By
Date Created