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    07 A Work Permit To Work at Height

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    07 A Work Permit To Work at Height

    Uploaded by

    Jai Shankar
    4 views2 pages
    for correction

    Original Title

    07 A Work Permit to work at Height (1)

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    07 A Work Permit To Work at Height

    Uploaded by

    Jai Shankar
    for correction

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    DCM Containers & Engineering Pvt Ltd

    Permit No. ………………….

    WORK PERMIT TO WORK AT HEIGHT

    NOTE:(1) The permit does not relieve the use of individual’s responsibility with respect to SAFETY.
    (2) The holder has to return permit to issuing authority after completion of job.
    (3) It must be made sure that worker on the job understands fully the hazard and risks involved.
    (4) The holder is not authorized to make utility connection of his own.
    (5) Stop work on emergency fire alarm or while required by issuing authority and leaving.
    (6) In case of emergency, leave the work site and assemble at assembly point.

    ISSUE: Permit is issued to Mr. ………………………………………………………………………………


    For section…………………………………………………………………...on date ………………………
    From starting date & time………………………….to expiry date & time………………………………….
    For job………………………………………………………………………………………………………..
    Job detail…………………………………………………………………………………………………......
    …………………………………………………………………………………………………………….…
    Location in plant/area………………………………………………………..................................................

    Safety check points to be verified before issue of work permit.

    YES NO Not applicable

    1. Awareness about safety requirements


    2. Stability of elevated work platform
    3. Step Ladder condition
    4. Mobile Scaffold condition
    5. Roof and / or anchor points
    6. Appropriate footwear (Preferably safety shoes)
    7. Safety Net
    8. Safety Belt / Harness
    9. Helmet
    10.Gloves (If Required)
    11.Goggles (If Required)

    (Permit Holder) Signature of Authorized person


    Permit Issuer (Head-HRD & Admin)
    Note: For Extension Please do entry on reserve side

    F/Admin/07-A, Issue No-01, Page 1 of 2


    DCM Containers & Engineering Pvt Ltd

    EXTENSION OF PERMIT:
    All precautionary checks have been reviewed afresh and found O.K. to renew permit:

    Date Time Signature

    From To Shift incharge Permit Applicant

    RETURN: The permit returned after work completion at Date & Time……………………………………..
    All man and materials have been removed.

    If Required A New Permit No. …………………..on Date …………………….has been issued in


    Continuation.

    SIGNATURE
    PERMIT APPLICANT

    F/Admin/07-A, Issue No-01, Page 2 of 2

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