Work Permit Decision
This is a straight forward checklist that needs to be followed when applying for a work permit. It also documents important information for the job you're applying for.
TX Whiskey
04/25/2024
Work Permit Decision
This is a straight forward checklist that needs to be followed when applying for a work permit. It also documents important information for the job you're applying for.
Does this Job or Task Include any of the following?
if the answer is "oneOf [Hot Work,Working at Heights,Excavation,Critical Lift,Live Electrical,High Voltage ,Line Break,Confined Space Entry]"
Safe Work Permit
Section A- Project Information
Contractor Name & Contact Number
Job Location
US Whiskey Project Manager Name and Contact Number
Date
Time
Section B- Nature of Work/Method Statement
What work are you doing?
How is this going to be performed?
Where will it happen?
Section C- Work Activities
Identify the work activities you will perform
if the answer is "oneOf [Other]"
What Other?
if the answer is "oneOf [Confined Space entry,Critical Lift,Excavation,Working at Heights,Hot Work,Line Breaking,Safety System OOS,Working on Energized Electrical Equipment,High Voltage (>1000V),High Pressure Blasting]"
Your activity requires an additional permit or risk assessment.
Section D- Actual and Potential Hazards
Identify the actual and potential hazards
if the answer is "oneOf [Other]"
What other?
if the answer is "oneOf [Other]"
What other?
Section E- Hazard Mitigation
Identify the PPE you will use to mitigate your risks.
if the answer is "oneOf [Gloves (Specify Below)]"
What type of gloves will you use?
if the answer is "oneOf [Other]"
What other?
Identify the Hazard Control Measures you will use to mitigate risks.
if the answer is "oneOf [Other]"
What other?
Section F- Risk Assessment & Controls
Identify the hazards, mitigation, and controls from sections D and E and perform a Job Safety Analysis
Hazard / Risk / Condition
Controls to Establish
(Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)
Company / Person Responsible
Hazard / Risk / Condition
Controls to Establish
(Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)
Company / Person Responsible
Hazard / Risk / Condition
Controls to Establish
(Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)
Company / Person Responsible
Hazard / Risk / Condition
Controls to Establish
(Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)
Company / Person Responsible
Section G- Acknowlegment
PERMIT I AM CERTIFYING THIS JOB & PERMIT WAS REVIEWED AND ISSUED BY:
Click here to sign
TIME ISSUED
TIME EXPIRES
PERMIT RECEIVER
Click here to sign
TIME ISSUED
TIME EXPIRES
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
PRE JOB FIELD REVIEW- PERMIT APPROVER AND TIME
PRE JOB FIELD REVIEW- PERMIT RECEIVER AND TIME
MID JOB FIELD REVIEW- PERMIT APPROVER AND TIME
MID JOB FIELD REVIEW- PERMIT RECEIVER AND TIME
POST JOB FIELD REVIEW- PERMIT APPROVER AND TIME
POST JOB FIELD REVIEW- PERMIT RECEIVER AND TIME
WAS THE JOB COMPLETED
Add or drag pictures
if the answer is "oneOf [None]"
Select what applies to your job or task
if the answer is "oneOf [The job or task includes recognized hazards. There is no SOP or JSA for the job or task,The job or task includes recognized hazards. There is an SOP or JSA in place. The task is performed less that every 6 months.]"
Safe Work Permit
Section A- Project Information
Contractor Name & Contact Number
Job Location
US Whiskey Project Manager Name and Contact Number
Date
Time
Section B- Nature of Work/Method Statement
What work are you doing?
How is this going to be performed?
Where will it happen?
Section C- Work Activities
Identify the work activities you will perform
if the answer is "oneOf [Other]"
What Other?
if the answer is "oneOf [Confined Space entry,Critical Lift,Excavation,Working at Heights,Hot Work,Line Breaking,Safety System OOS,Working on Energized Electrical Equipment,High Voltage (>1000V),High Pressure Blasting]"
Your activity requires an additional permit or risk assessment.
Section D- Actual and Potential Hazards
Identify the actual and potential hazards
if the answer is "oneOf [Other]"
What other?
if the answer is "oneOf [Other]"
What other?
Section E- Hazard Mitigation
Identify the PPE you will use to mitigate your risks.
if the answer is "oneOf [Gloves (Specify Below)]"
What type of gloves will you use?
if the answer is "oneOf [Other]"
What other?
Identify the Hazard Control Measures you will use to mitigate risks.
if the answer is "oneOf [Other]"
What other?
Section F- Risk Assessment & Controls
Identify the hazards, mitigation, and controls from sections D and E and perform a Job Safety Analysis
Hazard / Risk / Condition
Controls to Establish
(Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)
Company / Person Responsible
Hazard / Risk / Condition
Controls to Establish
(Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)
Company / Person Responsible
Hazard / Risk / Condition
Controls to Establish
(Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)
Company / Person Responsible
Hazard / Risk / Condition
Controls to Establish
(Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)
Company / Person Responsible
Section G- Acknowlegment
PERMIT I AM CERTIFYING THIS JOB & PERMIT WAS REVIEWED AND ISSUED BY:
Click here to sign
TIME ISSUED
TIME EXPIRES
PERMIT RECEIVER
Click here to sign
TIME ISSUED
TIME EXPIRES
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB
Click here to sign
PRE JOB FIELD REVIEW- PERMIT APPROVER AND TIME
PRE JOB FIELD REVIEW- PERMIT RECEIVER AND TIME
MID JOB FIELD REVIEW- PERMIT APPROVER AND TIME
MID JOB FIELD REVIEW- PERMIT RECEIVER AND TIME
POST JOB FIELD REVIEW- PERMIT APPROVER AND TIME
POST JOB FIELD REVIEW- PERMIT RECEIVER AND TIME
WAS THE JOB COMPLETED
Add or drag pictures
if the answer is "oneOf [The job or task does not include recognized hazards,The job or task includes recognized hazards. There is an SOP or JSA in place. The task is performed more than every 6 months.]"
No permit is required
Source: TX Whiskey (Community Member)