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    ForkLift PTW

    Uploaded by

    Js Williams
    Permit to work for forklift

    Copyright:

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

    ForkLift PTW

    Uploaded by

    Js Williams
    141 views3 pages
    Permit to work for forklift

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

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    Permit to work for forklift

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    141 views3 pages

    ForkLift PTW

    Uploaded by

    Js Williams
    Permit to work for forklift

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    You are on page 1of 3

    Health, Safety and Environment Effective Date: 27/05/2024

    Management System Procedure #: SSW. HSEMS.


    Issue: 1 Revision: 0
    Permit to Work Approved by:
    HSE Manager

    PTW –FORKLIFT OPERATION

    GENERAL INFORMATION
    Company: MFFL Permit No:
    Date: Location for forklift use: (provide a sketch if necessary):
    Description of forklift Activity:

    Description of Load: Forklift Make & Model:


    Total Weight of Load: Maximum Capacity of Forklift: TONS
    Forklift Power Source: DIESEL BATTERIES LPG OTHERS
    (Tick the answer)
    Permit Validity 7 days
    Start Date & Time: End date and Time:
    STAGE 1: APPLICATION BY THE SUPERVISOR.
    I shall ensure compliance with the below mentioned requirements prior to the lifting operations:

     Risk Assessment available for intended work.


     Ensure forklift operators are trained, competent and authorized.
     Operators have attended appropriate training when handling forklift with capacity of more than 5
    tones.
     Comply with the speed limit for forklift (10km/h).
     Ensure goods lifted are secured and within stipulated capacity of the forklift
     Daily pre-operation checklist for forklift is completed and attached following the duration of
    permit validity.
     Ensure servicing and inspection intervals of forklift in accordance with the specifications of the
    manufacturer.
     Ensure banks man in place to guide forklift when maneuvering in tight area or load is obstructing
    front view

    _________________ _____________ _____________ ______________ ______________


    Name and Designation Signature Date & Time Company Name Contact Number
    STAGE 2: ENDORSEMENT BY SAFETY PERSONNEL
    I have inspected and confirm that the recommended safety measure are in place

    Remarks if
    any:_________________________________________________________________________________

    _____________________________________________________________________________________

    1
    Health, Safety and Environment Effective Date: 27/05/2024
    Management System Procedure #: SSW. HSEMS.
    Issue: 1 Revision: 0
    Permit to Work Approved by:
    HSE Manager

    _________________ _____________ _____________ ______________ ______________


    Name and Designation Signature Date & Time Company Name Contact Number
    3. APPROVED BY PROJECT MANAGER/SITE MANAGER

    1. I have evaluated the hazards and risks associated with the job
    2. I have instructed the safety personnel to ensure the hazards and risks are eliminated or critically
    reduced to a contemporary objective standard and all recommended safety measures are in place.

    _________________ _____________ _____________ ______________ ______________


    Name and Designation Signature Date & Time Company Name Contact Number
    4. NOTIFICATION OF COMPLETION BY PERMIT HOLDER
    I confirm that the above stated work was completed and restored to safe condition. Housekeeping has
    been carried out.

    _________________ _____________ _____________ ______________ ______________


    Name and Designation Signature Date & Time Company Name Contact Number
    5. ACKNOWLEDGEMENT BY HSE DEPARTMENT
    I acknowledge that the permit is closed and is returned back to the HSE Department.

    _________________ _____________ _____________ ______________ ______________


    Name and Designation Signature Date & Time Company Name Contact Number

    VALIDATION/CHANGE PERMIT HOLDER

    THE PERMIT HOLDER CONFIRMS THE SCOPE OF THE SITE CONDITIONS ARE UNCHANGED
    AND THAT THE SAFETY PRECAUTIONS WILL BE OBSERVED BY ALL PERSONS WORKING
    UNDER THIS WORK PERMIT
    DATE TIME NAME SIGNATURE

    VALIDATION OF PERSONS WORKING UNDER THIS PERMIT TO WORK

    PERSONS WORKING UNDER THIS PTW CONFIRMS THAT THEY HAVE BEEN BRIEFED ON THE FULL
    SCOPE OF WORK, ATTENDED THE TOOL BOX MEETING, PARTICIPATED IN THE JOB SAFETY ANALYSIS
    AND DECLARE THAT THEY WILL ABIDE BY THE STATED WORK CONDITIONS. THE PERSONS UNDER
    THIS PTW ARE APPOINTED FOR THE SOLE PURPOSE FOR THE ABOVE DECLARED WORK ACTIVITY
    DATE TIME NAME SIGNATURE

    2
    Health, Safety and Environment Effective Date: 27/05/2024
    Management System Procedure #: SSW. HSEMS.
    Issue: 1 Revision: 0
    Permit to Work Approved by:
    HSE Manager

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