Permission to Work - Horizon Private School

Select the building *

Select the room number. *

Select the company name. *

Select the Date and Starting Time. *

Date

Time

Completion Time *

Select the reason for visiting. *

Type of Work *

In case you selected "Others", please clarify. *

Hazards (Select all that apply) *

Controls (Select all that apply) *

PPE (Select all that apply) *

Pre-Work Safety Confirmation (Select all that apply) *

Work Completion / Close out (Select all that apply) *

School Representative issuing the permit *

Permit Validity *

Verified by *

Signature