NIGHT WORK PERMIT - applicable from 6pm to 6am

A. To be filled by the person taking the permit

Permit required from: ___ pm/am to ___ pm/am Weather conditions
Site Engineer / Manager present during shift: Mobile:
Safety Officer present during shift: Mobile:
First Aider present during shift: Mobile:
Electrician present during shift: Mobile:
Whether emergency vehicle available: Mobile:
Exact location of work: No of workers:
Work to be carried out:

Sl No Description Yes No NA
1 Emergency vehicle and trained First-aider available during night shift
2 Approved RAMS available for the job
3 Adequate illumination is provided
4 All works in confined space prohibited, unless a separate permit to work is
5 Separate work permit obtained for hot work, excavation and work at height
6 Required PPE made available
7 Environmental conditions like unfavourable wind/rain considered
All electrically operated equipments have inspection tags and connection
8
drawn through RCCB
9 Safe access to workplace provided
10 All operator/driver fitness are checked
11 Female labour not permitted
Safety precautions proposed during activity:

I have inspected the above points and found to be complied with. I find it safe to remove the barricades /
guardrails / floor opening covers (delete as applicable ) for the proposed work.
Name of the work supervisor: Signature: Date:
Name of the work engineer: Signature: Date:
Verification by the contractor's H&S representative
I have inspected and verified the safety arrangements in the mentioned location. I find it satisfactory to
permit the works.
Name of the H&S representative Signature: Date:
Authorisation
I have cross-checked and found to comply with the safety precautions
Specific H&S remarks for to be taken care during / after the job:

Name of the issuing authority: Signature: Date:

Permit Closure
The floor edge / floor periphery has been barricaded / covered adequately
Name of the work supervisor: Signature: Date:
Name of the work engineer: Signature: Date:

SC13 v1706