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Cold Work Permit Form

Cold work or plastic deformation of metals can cause extreme physical injury caused by over pressing and rolling. Other factors like electrical and mechanical hazards, like the use of hand and power tools, add up to the overall risk which workers may encounter during operation. Use Lumiform to customize this template based on your business needs and requirements.

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Cold Work Permit Form

Audit

Scope of works
Permit valid from
Permit valid to

Potential Hazards and Controls

Depressurizing
Draining
Adequate lighting
Safety tags and locks
Electrical isolation
Mechanical isolation
Exposure to moving/rotating machinery
Confined space
Fall protection
Standby man
Ventilate properly
Warning notice
Potential flammable/explosive atmosphere
Potential high temperature
Potential high pressure
Potential exposure to hazardous materials
Excavation works

Personnel Protective Equipment

Select PPE to be used
Other PPE

Work Authorization

Full Name and Signature of Issuer
Full Name and Signature of Performer
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