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MA/PMC/HSE/SWP-01/Rev_01

MA CONSULTING SERVICES PVT. LTD.


PERMIT TO WORK – GENERAL
Note: 1) Under no circumstances the permitted work should be carried out after the closing time defined in this work permit.
2) Permit should be returned to the initiator on completion of work.
3) This permit is to be issued for defined scope of work and valid for a maximum period of 7days.

Permit No: -
A) DETAILS:

Name of Project Name of Contractor/Agency

Work Location Work Permit Start Date & Time

Scope of Work Work Permit Close Date & Time

B) POINTS TO BE CHECKED AT SITE:

Cont Site in PMC Block PMC MAN


DATE Cont Safety
Charge In charge Safety POWER

1 Make sure proper PPE to be provided.


YES/NO/NA

2 Ensure Safe access & Egress (Ladders) Provided.


YES/NO/NA

3 Make sure work force to use right tools for the


YES/NO/NA
right job.
4 Ensure all the floor openings to be closed.
YES/NO/NA

5 If scaffold used, condition of scaffolding &


YES/NO/NA
provision of tags to be ensured.
6 Extended work platform provided, if applicable
YES/NO/NA

7 Provide sufficient railing s.


YES/NO/NA

8 Visual inspection of tools &” Fit for Use” tagging, as


YES/NO/NA
applicable
9 Fencing of down area / Ground area done
YES/NO/NA

10 Proper housekeeping to be done.


YES/NO/NA

11 Ensure site supervisor to monitor Housekeeping.


YES/NO/NA

12 Is correct size tools used for the job?


YES/NO/NA

Any other requirement (If Yes, please specify):


Emergency exit are available. Emergency
vehicle and First-aid provider shall be assured
13 during the work YES/NO/NA
Main Isolation Switch location is known to All
Shock Treatment chart is available and is
understood through TBT

If any of the above criteria required is not met, then do not issue the Work Permit

C) AUTHORIZATION:

1 Requestor: I accept the conditions stated on the permit & certify that all persons under my control will be made fully aware of the method statement, aspects/hazards
as well as associated risks/control measures (see attachment).
2 Issuer: I hereby certify that the Checks/ precautionary measures as per Sr.no. B is confirmed. The permit recipient has been informed of all the conditions stated in the
method statement, aspects/hazards as well as associated risks/control measures.
3 Wherever EHS Officer is not available, Site In-Charge will perform the duties of EHS Officer.
4 Should permit not cover the current situation stated then this permit shall be cancelled & a new permit issued.

Contractor Site In charge Contractor Safety Officer PMC Safety Site-In-


PMC Site-In-Charge
(Requestor) (Checked by) Charge (Issuer)
Name/Signature
Mobile No
Date & Time

D) RETURN OF WORK PERMIT AFTER COMPLETION OF JOB:


All work carried out under this permit has been completed on Date: Time:

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MA/PMC/HSE/SWP-01/Rev_01

Contractor Site In charge Contractor Safety Officer PMC Safety Site-In-


PMC Site-In-Charge
(Requestor) (Checked by) Charge (Issuer)
Name/Signature
Mobile No
Date & Time

JSA (Job Safety Analysis)

Sr ACTIVITY
.N HAZARDS IDENTIFIED RISK CONTROL MEASURES RESPONSIBILE PERSON
o (List out the required
(Against each task list the (List the control measures required to (Write the name of the person
task in the sequence
hazards that could cause injury eliminate the risk of injury arising from the responsible (Supervisor (or)
to they are carried
when the task is performed) identified hazards) Permit Holder)
out)

Make sure to provide PPE. as per the work


condition Helmet, shoes, gloves etc.

Ensure that to provide right tools for the job.


Not using Proper PPE. Not
using right tools. Make sure to protect all the unsafe
Not protecting unsafe conditions (Floor opening, edge protection,
falling objects. Make sure to provide safe Site Engineer/Supervisor. &
1 General works. conditions. Not providing safe
access to work location, (Ladder, ramp or concern operators & workforce.
access.
Unskilled workforce. Not stairs.
providing proper information. Ensure that only skilled & experienced
workforce to be deployed.

Ensure to give information of work details &


location of works.
Proper training to be provided to the work
force on the specific job.
Ensure that while chipping works are carried
provide safety net & shade net at below the
level.
Barricade the area/Display of sign boards
below. Provide Stand by person.
Chipping. Drilling.
Not familiar with the Trained & qualified workforce to be deployed.
Working on the
equipment’s & tools.
floor. Landscaping
Unskilled workforce. Slip, trip &
Material shifting. Proper housekeeping to be done on daily Site Engineer/Supervisor. &
2 fall hazard. Overspending.
Vehicle movement. basis. concern operators & workforce.
Not following safety precautions.
Manual Cleaning. Speed limit boards to be displayed
Not using PPE.
Painting within the 10kmph.Only licenced drivers to be operate
Not familiar with the chemicals.
floors. the vehicle.
Provide all the safety measures &
precautions to be followed at work site.

Provide appropriate PPE to workforce.


Make them to understand about the
chemicals & paints.

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