Permit to work (PTW)
Step
1
of
3
33%
PERMIT NO.
This form is to be completed by all contractors planning on carrying out works at the Gladstone Airport site. Work will not commence without proper authorisation by a GAC representative. Refer HSE-PRO-002-Contractor Management.
SECTION 1 - Contractor to complete (email to
[email protected]
48 hours prior to work commencing)
If work has been requested by GAC, provide the relevant purchase order number:
Work requested by: (name)
Work requested by: (company)
Name of Contracting Company
Contractor Contact: (name)
Phone
Describe the work to be carried out:
Location of works:
Commencement date:
Expected duration of works:
Isolation will be required for:
Fire System
Gas
Water
Electricity
The work will involve:
Cutting / Drilling
Noise
Excavation
Working at Heights
Hot Work
Other
Will the work require contractors to enter the restricted areas (e.g. airside):
Yes
No
What Pre-Task Risk Assessments will be conducted:
Take 5
JSEA (please provide)
Other
SECTION 2 - GAC to complete
Requirements
Fire System Isolation
Fire System Isolation
Yes
No
Fire System Isolation | Permit No. (if relevant)
Isolation Permit
Isolation Permit
Yes
No
Isolation Permit | Permit No. (if relevant)
JSEA
JSEA
Yes
No
JSEA | Permit No. (if relevant)
GAC supervision
GAC supervision
Yes
No
GAC supervision | Permit No. (if relevant)
Current ASIC:
Current ASIC:
Yes
No
Current Induction:
Current Induction:
Yes
No
Register updated:
Register updated:
Yes
No
Work Authorised by: Name
Work Authorised by: Position
Work Authorised by: Position
MM slash DD slash YYYY
SECTION 3 - GAC to complete (once works completed)
Works have been completed and are satisfactory:
Yes
No
Comments:
All services have been restored:
All services have been restored:
Yes
No
Comments:
Authorised by: Name
Authorised by: Position
Authorised Date
MM slash DD slash YYYY
Δ
