Basic Work Permit
I. Work Permit Details
A. Permit Holder Information
Name: | [Your Name] |
ID: | [Your ID Number] |
Position: | [Your Position] |
Department: | [Your Department] |
Contact: | [Your Contact Information] |
B. Company Information
Company | [Your Company Name] |
Address: | [Your Company Address] |
Phone: | [Your Company Number] |
Email: | [Your Company Email] |
C. Work Details
Project/Task: | [Project/Task Name] |
Location: | [Work Location] |
Duration: | [Work Duration] |
Supervisor: | [Supervisor's Name] |
II. Safety Instructions
A. General Safety Guidelines
Wear appropriate PPE at all times.
Follow all safety protocols and procedures.
Report any hazards or incidents immediately.
B. Specific Safety Instructions
[Specific Safety Instruction 1]
[Specific Safety Instruction 2]
[Specific Safety Instruction 3]
III. Emergency Procedures
A. Emergency Contacts
Police: [Emergency Police Number]
Fire Department: [Emergency Fire Number]
Medical Emergency: [Emergency Medical Number]
B. Evacuation Plan
C. First Aid
IV. Authorization
A. Permit Issuer
I, [Issuing Authority], hereby authorize [Your Name] to undertake the specified work.
B. Permit Holder Acknowledgment
I, [Your Name], acknowledge that I have read and understood the safety instructions and emergency procedures outlined in this permit. I agree to comply with all regulations and requirements.
This permit is valid from [Start Date] to [End Date].
[Your Name]
Date: [Date]
Note: This permit is subject to revocation or modification at any time by the issuing authority.
Work Permit Templates @ Template.net
