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Work Permit Application

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IMPORTANT NOTES:

  1. This work permit is valid only for the task, location, and duration specified below
  2. In case of adverse weather conditions (e.g rain, flash floods, strong winds) this work permit will be void, and access to hazardous areas will be restricted
  3. Smoking is strictly prohibited in and around the work area
  4. Fire Safety Measures: Ensure the presence of fire extinguishers and confirm that an updated emergency response plan is in place
  5. Health Surveillance: The contractor must ensure health surveillance for personnel exposed to hazardous substances, as mandated by OSHA 2005

Personal Information

Section A: Work Details

Section B: Work Assessment

Section C: Safety and Compliance Checklist

Section D: Insurance Requirements

Section E: Acceptance and Approval

I confirm that I understand and will comply with all conditions, risk assessments and safety measures specified in this permit. Any accidents, incidents or injuries will be reported immediately, and emergency procedures will be followed.

Section F: Stop Work

Section G: Permit Close-out

I confirm that all work under this permit has been completed/partially completed and that all equipment has been returned in serviceable condition. The worksite has been left in a safe, secure condition.