Workplace Health & Safety Work Permit Form
Workplace Health & Safety Work Permit Form
This document ensures the safe execution of tasks, protecting our workers and promoting a secure work environment. Fill out accurately and completely.
Work Details
|
Work Description: |
Conducting Maintenance on Electrical Panels |
|
Location: |
Building A, Room 203 |
|
Equipment Tools: |
Insulated Gloves, Voltage Tester, Ladder |
Hazard Identification and Assessment
A. Hazard Identification
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Falls from Height
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Working on an elevated surface increases the risk of falls. |
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Material Handling
|
Lifting and carrying roofing materials pose ergonomic risks. |
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Weather Conditions
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Wind, rain, or other adverse weather conditions may affect safety. |
B. Risk Assessment
Please thoroughly assess each identified hazard and associated risks in the Hazard Identification and Assessment section. Utilize the provided table to document the likelihood, severity, and corresponding precautions and controls for each risk.
|
Risk |
Likelihood |
Severity |
Controls |
|
Falls from height |
High |
Moderate |
Install temporary guardrails around the work area. |
C. Safety Procedures
Carefully review and implement the safety procedures. Ensure that all workers are familiar with and adhere to these procedures before commencing work
Training and Qualifications
1. [Name]
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Completed fall protection training on [Month Day, Year].
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Certified in material handling safety on [Month Day, Year].
2. [Name]
-
Certified safety officer with training in roof work safety.
Authorization
A. Approval
[Name]
Work Supervisor
[Month Day, Year]
[Name]
Health & Safety Officer
[Month Day, Year]
[Name]
Management Representative
[Month Day, Year]
B. Duration and Validity
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Start Date:
-
End Date:
-
Conditions:
