Basic Work Permit Template
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Basic Work Permit

I. Work Permit Details

A. Permit Holder Information

Name:

[Your Name]

ID:

[Your ID Number]

Position:

[Your Position]

Department:

[Your Department]

Contact:

[Your Contact Information]

B. Company Information

Company

[Your Company Name]

Address:

[Your Company Address]

Phone:

[Your Company Number]

Email:

[Your Company Email]

C. Work Details

Project/Task:

[Project/Task Name]

Location:

[Work Location]

Duration:

[Work Duration]

Supervisor:

[Supervisor's Name]

II. Safety Instructions

A. General Safety Guidelines

  • Wear appropriate PPE at all times.

  • Follow all safety protocols and procedures.

  • Report any hazards or incidents immediately.

B. Specific Safety Instructions

  • [Specific Safety Instruction 1]

  • [Specific Safety Instruction 2]

  • [Specific Safety Instruction 3]

III. Emergency Procedures

A. Emergency Contacts

  • Police: [Emergency Police Number]

  • Fire Department: [Emergency Fire Number]

  • Medical Emergency: [Emergency Medical Number]

B. Evacuation Plan

  • Know the nearest exit routes.

  • Follow emergency evacuation procedures.

C. First Aid

  • Location of First Aid Kit: [First Aid Kit Location]

  • Trained First Aid Personnel: [Names of Trained Personnel]

IV. Authorization

A. Permit Issuer

I, [Issuing Authority], hereby authorize [Your Name] to undertake the specified work.

B. Permit Holder Acknowledgment

I, [Your Name], acknowledge that I have read and understood the safety instructions and emergency procedures outlined in this permit. I agree to comply with all regulations and requirements.

This permit is valid from [Start Date] to [End Date].

[Your Name]

Date: [Date]

Note: This permit is subject to revocation or modification at any time by the issuing authority.

Work Permit Templates @ Template.net