Working Permit

A. CONTRACTOR INFORMATION

Visitor/Contractor Name:

Date of Application:

Company Name:

Department:

Person(s) Entering / Name(s) of Personnel:

1	2	3
4	5

Contact Person:

B. AUTHORIZED SCHEDULE

C. PURPOSE OF ENTRY

Equipment/Machine Repair	Facility Maintenance	Others:
Rack Inspection	Facility Repair
Inventory Audit	IT/Systems Work

D. SPECIFIC WORK DESCRIPTION

E. EQUIPMENT/TOOLS TO BE BROUGHT INSIDE

QUANTITY	DESCRIPTION	BRAND/MODEL	SERIAL NO.	CONDITION (In)	ACTION

F. EQUIPMENT/TOOLS TO BE BROUGHT OUTSIDE

QUANTITY	DESCRIPTION	BRAND/MODEL	SERIAL NO.	CONDITION (Out)	ACTION

Approved by:

Requester
Signature Over Printed Name & Date

Department Head
Signature Over Printed Name & Date

Safety Officer/EHS Manager
Signature Over Printed Name & Date

Note: Working Permit should be accomplished 2-3 days before work schedule.
Please secure another work permit if work needs to be extended.
Kindly provide your personnel with appropriate PPEs (i.e. safety shoes, face mask, helmet).

Date of Entry:		Time (from):		Time (to):		Plant(s) to Visit:
Area to Access: Loading Bay Staging Area Consumables Racking Area Paper Rolls Area Engineering Racking Area Construction Racking Area Office Area MHE Area Co-packing Service Area Production Area Others (Please specify)