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    PTW LOTO Permit To Work (A) Details

    Uploaded by

    Zaki Azizi
    This document is a Lock-Out Tag-Out (LOTO) permit that provides details for work on a system or component. It includes information such as the permit number, location, requester details, validity dates, reason for request, checklist for requester, and spaces for extensions and signatures. The permit is valid for one shift initially and can be extended up to 6 consecutive days if approved. Workers must follow approved safety procedures and the area must be barricaded and signed.

    Copyright:

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

    PTW LOTO Permit To Work (A) Details

    Uploaded by

    Zaki Azizi
    157 views4 pages
    This document is a Lock-Out Tag-Out (LOTO) permit that provides details for work on a system or component. It includes information such as the permit number, location, requester details, validity dates, reason for request, checklist for requester, and spaces for extensions and signatures. The permit is valid for one shift initially and can be extended up to 6 consecutive days if approved. Workers must follow approved safety procedures and the area must be barricaded and signed.

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    PTW LOTO Permit to Work (A) Details

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    © © All Rights Reserved

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    This document is a Lock-Out Tag-Out (LOTO) permit that provides details for work on a system or component. It includes information such as the permit number, location, requester details, validity dates, reason for request, checklist for requester, and spaces for extensions and signatures. The permit is valid for one shift initially and can be extended up to 6 consecutive days if approved. Workers must follow approved safety procedures and the area must be barricaded and signed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    157 views4 pages

    PTW LOTO Permit To Work (A) Details

    Uploaded by

    Zaki Azizi
    This document is a Lock-Out Tag-Out (LOTO) permit that provides details for work on a system or component. It includes information such as the permit number, location, requester details, validity dates, reason for request, checklist for requester, and spaces for extensions and signatures. The permit is valid for one shift initially and can be extended up to 6 consecutive days if approved. Workers must follow approved safety procedures and the area must be barricaded and signed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    LOTO PERMIT (A)

    System / Component Safety Tagging Permit (LOTO Office)


    PTW Details
    Permit No: Location
    PTW Requestor
    Name Name
    Designation Designation
    Signature Signature
    Entity Electrical Mechanical Testing & Commissioning
    PTW Validity
    PTW Validity From To Date
    Reason for PTW Request (Detail Description)

    Note: This Permit should be considered suspended, if any emergency declared at site. This permit will be valid for One
    working shift and could be extended by Permit Issuer, on request from Permit Requester. Extension of permit should
    not be (for) more than one additional working shift, and up to Six consecutive days. Extension sheets should be used
    for, permit extension and, if needed to record locks/tags details. Permit issuer endorsement is mandatory, prior to start.
    Work should be carried out as per approved procedure/method statement.
    Approved by tagging Authority
    Name
    Designation
    Signature
    Date
    PTW Closed by:
    Tagging Authority Tagging Authority
    Name Name Name
    Designation Designation Designation
    Signature Signature Signature
    Date & Date & Date &
    Time Time Time
    LOTO PERMIT (A)
    System / Component Safety Tagging Permit (LOTO Office)

    Checklist to be filled by Permit Requester

    Description Yes () NO (×)

    Method statement is in place?

    Job safety analysis in place?

    Is there safe access to


    workplace?

    Adequate signage’s displayed?

    LOTO officer inspected the


    workplace?

    Task briefing delivered by


    technical engineer to all
    involved workers and signed?

    Is the workplace safe from


    environment risks?

    Area is barricaded to avoid


    unauthorized entry?

    All necessary precautions


    taken/STARRT completed,
    prior starting activity and
    verified by LOTO officer?

    All equipment and devices are


    free from damage?
    LOTO PERMIT (A)
    System / Component Safety Tagging Permit (LOTO Office)

    EXTENSION REQUEST EXTENSION PERMIT REQUESTER PERMIT ISSUER &


    TIME & DATE VALID UP TO SIGNATURE HSE Dep. SIGNATURE

    Permit Extension Sheet


    LOTO PERMIT (A)
    System / Component Safety Tagging Permit (LOTO Office)

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