Greencore Group


SHE Management System
Safety, Health and Environmental Guidelines

another Head Office Link

LEVEL 3 GUIDANCE - Section: 03.200.SHE
Prepared By: T Chambers
Approved By: V Craig
Date: March 1999 - Rev: 0 ISSUE 1

PERMIT TO WORK CERTIFICATE

 

  1. THIS Greencore Group 'PERMIT TO WORK'
    AND THE CONDITIONS CONTAINED IN IT ARE MANDATORY.
  2. WORK OF ANY KIND BY A CONTRACTOR, THEIR AGENT OR EMPLOYEES
    IS EXPRESSLY FORBIDDEN WITHOUT A VALID PERMIT TO WORK.
  3. THIS PERMIT IS ONLY VALID FOR 24 hrs (UNLESS RE-VALIDATED SEE BELOW).
  4. THE PERMIT MUST BE RENEWED EVERY MONDAY MORNING (NOT RE-VALIDATED)
  5. THE ORIGINAL PERMIT IS ISSUED,
    WHILST A COPY MUST BE RETAINED FOR INSPECTION
  6. UPON COMPLETION OF WORK
    OR WHEN THE CONTRACTOR LEAVES THE INSTALLATION FOR AN EXTENDED PERIOD THIS PERMIT MUST BE RETURNED TO THE Greencore Group.
  7. THE Greencore Group MAY WITHHOLD THE ISSUE OF A PERMIT
    IF OLD PERMITS ARE NOT RETURNED TO ITS REPRESENTATIVES.
  8. BY SIGNING THIS PERMIT THE CONTRACTOR/EMPLOYEE IS INDICATING
    THAT THEY HAVE READ THIS DOCUMENT
    AND AGREE TO ABIDE BY ALL THE CONDITIONS CONTAINED IN IT.
  9. THIS PERMIT MUST BE REVALIDATED NO LATER
    THAN 10 am OF EACH CALENDER DAY AFTER ISSUE.
01. PERMIT NUMBER...

PERMIT ISSUE...

DATE

DAY MONTH YEAR TIME OF ISSUE
AM PM


02 COSHH ASS No.

03 Greencore Group LOCATION

04 WORK PERMITTED

05 OTHER CERTIFICATES

ENTRY HOT WORK COLD WORK TOXIC\NAKED LIGHT


06 HAZARD TYPE

FLAMMABLECORROSIVEHARMFULOXIDIZING
IRRITANT HAZARDOUS ENVIRONMENT EXPLOSIVE TOXIC
OXYGEN ASBESTOS COMPRESSED GAS ELECTRICAL


07 ISOLATION REQUIRED

YES NO DETAIL


08 P.P.E

HELMET GOGGLES CHEM SUIT GLOVES
WELLINGTONS SELF CON B.AAIR LINE BREATHING POSITIVE PRESSURE RESPIRATOR
HEARING DEFENCE HARNESS\FALL ARREST IMPERVIOUS OVERALLS OTHERS:


09 WORK EXCLUSIONS

I certify that I have personally inspected the location and plant described above and that conditions have been made safe for the work to be carried out.

10 PRINT AUTHORISATION NAME POSITION.
11 Greencore Group SIGNATURE.
12 FIRE EQUIP LOCATION.
13 ACCEPTANCE NAME (Print) & SIGNATURE. Co.


I certify that I have personally inspected the location and plant described above and to the best of my knowledge it is complete, and is accepted back in to production.

14) PRINT NAME.POSITION
15) SIGNATURE. DATE.
EXTENSION DATE FROM
EXTENSION TIME
EXPIRY DATE
EXPIRY TIME
EXTENSION ISSUED OR HANDED OVER BY
(Greencore Group SIGNATURE ONLY)
Greencore Group POSITION

 

 
  
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Revised: December 01, 2004.
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