Safety Work Permit: Instruction

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SAFETY WORK PERMIT

Safety Work Permit


Permit No.___________

Date.___________________

Instruction:1. This permit should be displayed / available at the site of work.


2. Permit is valid during office hours only (9:00 AM to 6:00 PM). Work extension permission shall be taken if
needed from concerned In-Charge
3. Send the permit to safety dept after completion of job

A. 1. Permit required for: General Work/Hot Work/Work at height/ Excavation/Electrical


connection.
2. Location: _____________________________________________________________
3. Description of Work: ______________________________________________________
4. Stand by Person required for helping. Name of the person: __________________

B. Personnel protective equipment required: Safety goggles /Safety shoes /


C. safety helmet /hand gloves /dust mask /safety belt / welding shield any
other :_____________________________________________________________________
__

D. Equipment and tools required: Ladder/ drilling machine/ hack saw/chisel & hammer/Hand
tools/ portable lamp/ fire extinguisher/ specify any
other:___________________________________________________________________

E. General Instruction Yes No NA


1. Equipment Properly clean
2. Equipment Effectively isolated
3. Area properly barricaded
4. Person need training
5. Person conducting the activity is physically & mentally fit.
6. No flammable material stored near.
7. Ladder required
8. Ventilation and lighting are provided
9. RCCB is provided to welding machine
SAFETY WORK PERMIT

F. 1.Area releasefor work at._____________Hrs,


2. Name of the contractor. (If Any)_______________________________
3. HSE Policy, PPE Policy communicated to contractor_________
4. Safety dept. comments. ____________________________________

Verified the above check points Allotted the area for carrying I have understood the job. I will
by Safety Officer: out the activity. take necessary precaution and
follow the instruction given to me

Safety Officer’s Sign Concerned In-Charge Sign Contractor’s Sign

_______________________ ______________________ _____________________


(Verified the above check points)

F Job completed at Hrs. ________________On _____________________

Concerned In-charge Sign_____________________________________

Safety Officer’s Sign for closing the permit _________________________

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