Site Access Permit Form
Permit To Work
PTW Permit Number :
Permit-ID-YEAR
Submitted By - Telikom Employee
*
First Name
Last Name
Email Address
*
Enter E-mail Address of Telikom Employee Submitting Request
Access Seeker Email
Enter E-mail Address of External Access Seeker
Start date
*
-
Day
-
Month
Year
Date
End Date
*
-
Day
-
Month
Year
Date
Vehicle Registration Number
*
People Visiting The Site
Staff
Purpose of visit to site
Duration
Location
1
2
3
4
5
Endorsed By
*
Approved By NOC
NOC Level
Approved By
*
CTO Level
Approved By CEO
CEO Level
Submit
Should be Empty: