COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

SAFE WORK PERMIT ❑ Confined Space Entry ❑ Hot Work ❑ Line Breaking Location: WO Number ERM Scope of Work: Issued To: Issued By: Date&Time Issued Date&Time Expires Section General Information,, Com leteforall ermits'. 1. Job Specific Hazards ❑ Worksite Chemicals ❑ Atmospheric Hazards ❑ Thermal Burns ❑ Chemical Burns ❑ Corrosives ❑ Flammable Liquids ❑ Reactive Liquids ❑ Toxic Substances ❑ Ignition Sources ❑ Electrical Hazards ❑ Electrical Cords ❑ Falls above 4' ❑ Steam ❑ Vehicle Traffic ❑ Adjacent Work ❑ Heat Stress/Cold Injuries ❑ High Pressure ❑ Radiation ❑ Noise ❑ Pinch Points ❑ Other 2. PPE/Equipment ❑ Inner Gloves ❑ Half-faced Respirator ❑ Welding Shield ❑ Tripod w/lifting device ❑ Outer Gloves ❑ Full-Faced Respirator ❑ Spark Proof Tools ❑ Harness ❑ Chemical Suit ❑ Line Air Respirator ❑ Fire Extinguisher(s) ❑ Ventilation ❑ Poly Coated Suit ❑ SCBA ❑ Decon Materials ❑ Work lights ❑ Hearing Protection ❑ Chemical Goggles ❑ First Aid Kit ❑ GFCI ❑ Safety Shoes/Boots ❑ Face Shield ❑ Eyewash Station ❑ Two-way Radio ❑ Safety Glasses w/ ❑ Hard Hat ❑ Spill Response ❑ Barricades/Waming Side Shield Equipment Signals ❑ Other 3. Rescue and Emergency Services Service Name: Contact Name: Telephone Number: SectionlI Cori Space be Entered:S aee Eii 1. p red: 2. Purpose of Entry: 3. Describe how the hazards identified in Section I have been addresses/isolated: 4. Describe Communication Procedures used by Entrant and Attendant during entry: Section III Hot Work 1. Equipment to be worked on: 2. Precautions: ❑ Fire hazards removed from area ❑ Floor/wall openings covered ❑ Area inspected by Supervisor ❑ Welding equipment inspected ❑ Fire extinguishers at location ❑ Atmospheric tests complete ❑ Spark and heat guards in place ❑ Fire watch posted(>30 min) ❑ Adequate ventilation 3. Name of Fire Watch: Fire watch start time: Fire watch end time: