Permit Request • CampusOptics

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Name* Required

Additional Location Details

Hazardous Work

Roof Work* Required

I will be working on a roof so I need to fill out a roof work permit safety plan.
I will not be working on a roof.

Hot Work* Required

I will be doing hot work and need to fill out a hot work permit and set up a fire watch.
I will not be doing hot work.

Confined Space Entry* Required

I will be entering a confined space so I will need to make a safety plan.
I will not be entering any confined spaces.

Modifying Infrastructure* Required

I will be modifying the floor, walls or ceiling so I need to check the door frame for the asbestos sticker and refer to the asbestos inventory.
I will not be modifying infrastructure.

Working in Public* Required

I will be working in public so I need to follow the Working in Public SWP and set up a safety zone around my work area.
I will not be working in public.

Driving a vehicle on to campus. * Required

I am going to drive a vehicle on to campus so I need a spotter to escort me.
I will not be driving a vehicle on to campus.

Hazardous Energy* Required

I will be working around hazardous energy so I will need to use a lockout/ tag out.
I will not be working with hazardous energy.

Working Alone* Required

I will be working alone so I need to set up a work alone plan with my supervisor or co-worker.
I will not be working alone.

Hazards Group

Assess the Risk

Rank the hazards and identify the control plan. Give each hazard a rank of severity and probability. * Required

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files

Risk Assessment Permit Request

Requester Info

Permit Date & Time

Fire Watch Date & Time

Location

Hazardous Work

Hazards Group

Assess the Risk

Add Supporting Documents

Requester Info

Permit Date & Time

Fire Watch Date & Time

Location

Hazardous Work More information

Hazards Group More information

Assess the Risk More information

Add Supporting Documents

Hazardous Work

Hazards Group

Assess the Risk