General
General
General
Permit No: -
A) DETAILS:
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.
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MA/PMC/HSE/SWP-01/Rev_01
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)
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