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Job Setup:
Operating Area…
Cook Inlet Offshore
Nikiski Onshore
Anchorage
Other
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Set once. Attaches to every form you submit.
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📋 General Work Authorization
Unit Work Permit
Maintenance, Repair & General Operations
ℹ️
NOTE:
Complete a Job Safety Analysis (JSA) before starting work. Additional permits may be required for hot work, confined space, LOTO, or excavation.
📝 New Permit
✅ Close Out Permit
📋
Permit Information
District / Base
*
Select District / Base...
Allegra Leigh (formerly Julius R)
Spartan 151 jack-up
Other
Date
*
Start Time
*
Expected End Time
*
Work Location
*
Specific Area
Work Type
*
Select...
Maintenance
Repair
Inspection
Installation
Removal
Testing
Cleaning
Painting/Coating
Rigging/Lifting
Other
Risk Level
*
Select...
Low - Routine Work
Medium - Some Hazards Present
High - Significant Hazards
Critical - Multiple High Hazards
Work Description
*
👥
Personnel
Permit Issuer
*
Work Supervisor
*
Workers Assigned (one per line)
📄
Additional Permits
Additional Permits Required?
*
Select...
None Required
Hot Work Permit
Confined Space Entry
LOTO Required
Excavation Permit
Opening & Blinding
Multiple Permits Required
Related Permit Numbers
⚠️
Hazard Assessment
Check all hazards present:
Fall Hazard
Pinch Points
Rotating Equipment
Overhead Hazards
Chemical Exposure
Noise Hazard
Electrical Hazard
Pressure Systems
Hot Surfaces
Sharp Edges
Other Hazards / Details
🛡️
Controls & Precautions
Area barricaded/roped off?
--
Yes
No
N/A
Warning signs posted?
--
Yes
No
N/A
Equipment de-energized?
--
Yes
No
N/A
Tools inspected?
--
Yes
No
Lifting plan required?
--
Yes
No
Lifting plan approved?
--
Yes
No
N/A
📝
Job Safety Analysis
JSA/THA Completed?
--
Yes
No
JSA reviewed with crew?
--
Yes
No
Stop Work Authority discussed?
--
Yes
No
🦺
Required PPE
Hard Hat
--
Yes
No
Safety Glasses
--
Yes
No
Face Shield
--
Yes
No
N/A
Hearing Protection
--
Yes
No
N/A
Safety Boots
--
Yes
No
Gloves
--
Yes
No
FR Clothing
--
Yes
No
Fall Protection
--
Yes
No
N/A
✍️
Authorization Signatures
Permit Issuer Signature
*
Work Supervisor Signature
*
📋 Issue Unit Work Permit
AnthroSafe™ Field Driven Safety
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