PTW Form

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					                                                                                 This Application, once signed and completed with all relevant
PERMIT TO WORK – APPLICATION                                                  associated OH&S system documentation and high-risk permits, is to
                                                                                be forwarded via hardcopy or email to the relevant BAC contact
WORK CLEARANCE & AUTHORISATION PERMIT                                            person for review. Work relating to this Application must not
                                                                              commence unless formal approval has been given and a PTW Issued.


1. DESCRIPTION OF WORK                                                                                       Work Coordinator / Contractor Representative
Work to be done:                                                                  Company / entity doing the work:



                                                                                  BAC Contractor Class:                A B C D E
Location of work:
Estimated duration of work:

2. TYPE OF CLEARANCE / AUTHORISATION REQUESTED                                                               Work Coordinator / Contractor Representative
 Work Authorisation                        Work Clearance
        work is required at a BAC controlled area               OR                  work is required at a designated Principal Contractor controlled site
        the nature of the work requires a PTW Work                                   OR a Tenant location under lease
         Authorisation to be issued by BAC                                           work is NOT deemed to be BAC organised and controlled
                                                                                     the nature of the work is required to be notified to BAC so that a
                                                                                      PTW Work Clearance can be issued

3. WORK DETAILS                                                                                              Work Coordinator / Contractor Representative
The Work Authorisation work:                                                 The Work Clearance work will require:
    fits the definition of a Designated Permit Activity                         changed traffic conditions within BAC controlled areas so that it can be
                                                                                  performed safely, (lane closures, reduced speeds, etc)
    will be in immediate proximity to motorists

    will be in immediate proximity to members of the public                     a specific energy isolation to be undertaken on BAC controlled assets or
                                                                                  installations so that work can be performed safely
     where basic exclusion controls such as barrier mesh is
     not deemed adequate to manage the risks involved                            significant floor space or access ways within a terminal building public
     with the activity                                                            access area or neighbouring common public access area, to be closed
                                                                                  off or affected, (as part of work preparation, movement of materials, etc)
    will be of a type that the BAC works coordinator for that
     work deems worthy of PTW control                                            significant noise emissions that may exceed daily noise dose levels

    requires specific clearance as per the Airports Act due
     to the location being one that is airside
                                                                                 the creation of dust in large quantities that may have the potential to be
                                                                                  recirculated throughout a terminal building’s or BAC controlled building’s
                                                                                  air supply
    requires formal permission due to the work being near
     JUHI fuel lines, or Airtrain high voltage lines, or the                     the use of cleaning, painting, or similar substances in large quantities
     OLS (Obstacle Limitation Surface)                                            that may have the potential to be recirculated throughout a terminal
                                                                                  building’s or BAC controlled building’s air supply
    requires a High-Risk Permit (one or more of the
     following: Confined Space Entry Permit, Hot Work                            formal BAC acceptance via the Airport Building Control process
     Permit, Work at Heights Access Permit, Electrical
     Access Permit, Excavation Permit, Plant Isolation                           formal permission due to the work being near JUHI fuel lines, or Airtrain
                                                                                  high voltage lines, or the OLS (Obstacle Limitation Surface)
     Handover Form, HV Switching Sheet)
                                                                                 will require BAC clearance due to nature/location of works (eg. airside)


              For additional explanatory information relating to what scope of work requires Work Authorisation or
              Work Clearance refer to the OH&S PTW Information section within the Working at Brisbane Airport
              website: www.workingatbrisbaneairport.com

4. SYSTEM CONTROLS                                                                                        Work Coordinator / Contractor Representative
 Safe Work Plan                                                 I, the Work Coordinator / Contractor Representative for the above work hereby
                                                                 acknowledge that I understand my responsibilities under this PTW, have undertaken
 Work Method Statement / Risk Assessment / JSA                  adequate pre-work planning to identify & document suitable safe methods of work, and
 Designated Work Procedure(s)                                   commit to ensuring that the methods and controls identified will be communicated to all
                                                                 relevant Personnel involved with the work and that adequate supervision will be in
 Confined Space Entry Permit                                    place to monitor the effectiveness of chosen controls.
 Hot Work Permit
 Work at Heights Access Permit                                  Signature                                               Date                   Time

 Electrical Access Permit
 Excavation Permit                                              Name                                                    Contact Number

 Plant Isolation Handover Form /  HV Switching Sheet           Company Name
 Other:
 Other:                                                         Project Number                                          Name of BAC Contact / Key Report Person



              As required by BAC & as checked off above, the necessary system control documentation is to be
              attached to this Application. For additional explanatory information relating to BAC Safe Work Plan
              requirements and blank templates of a Safe Work Plan & High-Risk Permits that may need to be
              completed as part of this Application, refer to the OH&S PTW Information section within the Working
              at Brisbane Airport website: www.workingatbrisbaneairport.com

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