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    Permit - Rev 1

    Uploaded by

    Ridwan Ono
    The document is a work permit application for a shoe factory project. It provides information on the contractor, supervisor, safety officers, number of workers, job description, required PPE, attached documents, tool conditions, and hazard controls. Signatures are required from managers and supervisors to approve the permit.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    Permit - Rev 1

    Uploaded by

    Ridwan Ono
    7 views1 page
    The document is a work permit application for a shoe factory project. It provides information on the contractor, supervisor, safety officers, number of workers, job description, required PPE, attached documents, tool conditions, and hazard controls. Signatures are required from managers and supervisors to approve the permit.

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    permit_rev 1

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    © © All Rights Reserved

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    The document is a work permit application for a shoe factory project. It provides information on the contractor, supervisor, safety officers, number of workers, job description, required PPE, attached documents, tool conditions, and hazard controls. Signatures are required from managers and supervisors to approve the permit.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    7 views1 page

    Permit - Rev 1

    Uploaded by

    Ridwan Ono
    The document is a work permit application for a shoe factory project. It provides information on the contractor, supervisor, safety officers, number of workers, job description, required PPE, attached documents, tool conditions, and hazard controls. Signatures are required from managers and supervisors to approve the permit.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    You are on page 1of 1

    WORK PERMIT

    Name Project PCG Central Java Industrial Shoes Factory Date of filing

    Contractor Name Date Period S/D

    Supervisor Time S/D

    SHE Officer Number of workers Workers


    Job location
    Job Description
    No PTW -SH&E/PTW/WP2/ /24

    Y N PPE to be used
    Approved Method statement attached No MS : Helmet, vest, safety shoes (mandatory)
    Approved SWP & JSA attached No JSA : Others:

    Update Drawing location attached


    All tools and equipment in good condition
    Works not creating safety hazard for its surrounding
    No pending technical issues related this work
    Specific Hazard and control measure :

    Noted : High-risk work activities must obtain separate permits,


    Please attach the name of the worker

    Permit Validation Applicant ISSUER A Knowledge


    CREMONA DELTA RADIAN
    Contractor Site Manager Contractor SHE Manager PCG-HAI
    CSA/MEP SHE

    Supervisor in charge* :

    SHE supervisor in charge :


    by signing this form the Applicant understands and agrees te he is responsible to ensure the work will be conducted in a safe manor and in compliance with the work instruction
    file , and the agreed safety standards based on safety procedure. *supervisor shall conduct daily checklist

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