Basic Work Permit
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
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Wear appropriate PPE at all times.
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Follow all safety protocols and procedures.
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Report any hazards or incidents immediately.
B. Specific Safety Instructions
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[Specific Safety Instruction 1]
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[Specific Safety Instruction 2]
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[Specific Safety Instruction 3]
III. Emergency Procedures
A. Emergency Contacts
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Police: [Emergency Police Number]
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Fire Department: [Emergency Fire Number]
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Medical Emergency: [Emergency Medical Number]
B. Evacuation Plan
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Know the nearest exit routes.
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Follow emergency evacuation procedures.
C. First Aid
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Location of First Aid Kit: [First Aid Kit Location]
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Trained First Aid Personnel: [Names of Trained Personnel]
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.
