{OrganisationBanner}

Doc No: {DocumentNumber}

Permit To Work Report - {JobTypeName} (Permit UID - {PermitToWorkUId})

Permit Information

Type of permit Name of project/site Contractor company Name of client/contractor
{JobTypeName} {SiteName} {CompanyName} {RequestedByName}

Work Information

Start date / Close Date {PermitToWorkStartDate} / {PermitToWorkEndDate} Work location {WorkLocation}
Start time / End time {PtwStartTime} / {PtwEndTime} Reference permit no. {ReferencePermitNumber}
No. of workers {NoOfWorkers} Tools/ equipment to be used {ToolsUsed}
Scope of work {ScopeOfWork}
Description of work {WorkDescription}

Hazards

{Hazards}

Precautions Taken

{Precautions Taken}

PPEs

{Job Specific PPEs}

Safety Considerations

{Safety Considerations}

Toolbox Talks

{Toolbox Talks}

Approval and authorization

Requestor Issuer Approver Reviewer
Name: {RequestedByName}
Phone: {RequestedByMobileNumber}
Requested On: {RequestedOn} 		Name: {IssuedByName}
Phone: {IssuedByMobileNumber}
Issued On: {IssuedOn} 		Name: {ApprovedByName}
Phone: {ApprovedByMobileNumber}
Approved On: {ApprovedOn} 		Name: {ReviewedByName}
Phone: {ReviewedByMobileNumber}
Reviewed On: {ReviewedOn}
{Extensions}

Permit To Work History

{PtwHistory}
Created On Created By Comment Attachments