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General Work Permit

This document is a permit to work form for general work being conducted at the Lodha Park project. It contains details of the work activity, location, date, and applicant. It lists precautions that must be checked like training, inspections, and use of protective equipment. The applicant and multiple levels of authorization are required. An annex lists authorized workers. Upon work completion, the applicant and HPM close the permit by verifying the work area is cleaned and materials removed.

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Amol Kamble
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9K views2 pages

General Work Permit

This document is a permit to work form for general work being conducted at the Lodha Park project. It contains details of the work activity, location, date, and applicant. It lists precautions that must be checked like training, inspections, and use of protective equipment. The applicant and multiple levels of authorization are required. An annex lists authorized workers. Upon work completion, the applicant and HPM close the permit by verifying the work area is cleaned and materials removed.

Uploaded by

Amol Kamble
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • General Work Permit: Contains detailed information about the permit including project details, precautions, and necessary approvals before commencement of work.
  • Authorized Personnel List: A list format for recording the names and details of individuals authorized to work under the specified permit.

HPM-WP-001

PERMIT TO WORK- GENERAL WORK

Permit No:

Section – I GENERAL DETAILS

Project Name LODHA PARK

Activity / Type of work


Area / Location
Date : Start Time : AM/PM End Time : AM/PM
Permit Applicant Name
No of Workers Involved
Contractor Name

Section – II PRECAUTIONS TO AVOID POTENTIAL HAZARDS

PRIOR TO COMMENCEMENT YES / NO PRIOR TO COMMENCEMENT YES / NO


Are all labours trained for the specific Is electricity going to be used?
job?
Tool box talk conducted? All tools & equipment are in healthy
condition & thoroughly inspected?
Supervisor available full time? Any pressurized vessels are going
to be used?
PPE available to all workers? Any power tools/heat generating
tools are going to be used?
Any activity producing high noise? Is there any Hot work/Height work?

Section – III (Permit Requested by):


I request for a permit for the above mentioned work at the location specified above. I have personally
inspected the work place to ensure that requirements needed and precautionary measures as
mentioned above have been complied with.
Checked by
Name Designation Signature
Contractor site In charge

Authorized by CM Name Designation Signature

Authorized by HPM Name Designation Signature

Name Designation Signature


Authorized by SFS

Any Other Remarks :

Section – IV PERMIT CLOSURE (PLEASE ENSURE TO CLOSE THE PERMIT)


The above job is completed at ……..am/pm, and ensured that work area is cleaned & all materials are
removed. All work persons have left from site.

Permit Applicant (Name)……………………..Signature: ……………………..Date & Time: …………………..

The above work is completed, permit closed & permit submitted to HPM.

Authorized HPM (Name): ……………………….Signature: ……………………. Date & Time: ……………….…

WP- General Work Page 1 of 2


HPM-WP-001

Annexure - 1: List of persons authorized to work for this activity.

SR Name of Workmen/Staff Trade Contractor Name Signature


No.

10

11

12

13

14

15

16

17

18

19

20

Note: No unauthorized person, other than listed above, shall be engaged in for this activity.

Name (Contractor Work In charge): …………………………………… Signature:


………………………………

WP- General Work Page 2 of 2

WP- General Work Page 1 of 2 HPM-WP-001 PERMIT TO WORK- GENERAL WORK
WP- General Work Page 2 of 2 HPM-WP-001 Annexure - 1: List of persons authorized to work for this activity.

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