SUNDAY / HOLIDAY WORK PERMIT

Permit No:- Date:-

'A' GENERAL DETAILS

Date of Issue:- Work Day & Date From :- To:-
Project Name:- Cost Canter:-
Exact Area/Location:-
Type of Work:-
Detailed Description of Work to be Carried Out:-
'B' DETAILS OF RESPONSIBLE PERSON CARRYING OUT WORK:-
Name of Person Permit Issued To:- Vender Name
Contact No:-

'C' SAFETY PRECAUTIONS

Risk Assessments Provided ? Yes No N/A
Safe Work Method Statement Provided? Yes No N/A
Local Emergency Procedure Explained Yes No N/A
Competent Supervisor to Oversee the Work Yes No N/A
Required PPEs Provided? Yes No N/A

Name 0f the Person Working Gate Pass No Name 0f the Person Working Gate Pass No

'D' AUTHORISATION TO WORK

I hereby declare that the necessary precaution have been put into place and that work specified in part 'A' is
authorised to commence.

Signed (Building Engg.) Name of Building Engg. Date Time

'E' ACCEPTANCE

I hereby declare that I accept responsibility for carrying out the holiday work detailed in part 'A' of this permit and
that no attempt will be made by me or by persons under my control to work in any areas. Appropriate safety
precautions will be taken at all time.

Signed (Vender representative) Name of Contractor Date Time

Project Incharge Safety Dept. Security Dept.

 Debit Charges Against Violation Of Safety Norms
Safety Infringement Will Not Be Acceptable At Site And Anyone Found Violating The Safety
Nome's Shall Be Liable For Heavy Penalties
No. Nature Of Offence Amount Of Safety Debit To Be levied
Against the Vendor/ Staff/Sub Contractor
For Non-Adherence Of Safety Norms

Smoking in an unauthorized area and/or consumption of alcohol

and/or use of illegal substances at construction site.
1 Rs, 5000.00

Personal Safety-
Failure to wear personal protective equipment (PPEs)

1) Without Helmet for Vendor. Rs,1000

2) Without Helmet/Safety Shoes/Jacket for Vendor Staff. Rs,1000
3) Without Helmet /Safety Shoes/Jacket for Worker. Rs,1000
4) Without Safety Belt ( Full Body Harness)
2 (Safety belt Which shall include failure to anchor belt to a secure
structure. Those are working on height more than 1.8 mars as per Rs,2000
statutory rules)

5) Without Helmet/Safety Shoes/Jacket/Safety Pocket book

for staff.
Where any site operation the use of PPEs then all worker must use the One Day Salary
required PPEs e.g. Shuttering /DE shuttering / grinding / Welding /
Painting / unloading hazardous materials etc.

Occupational Safety (Building Safety)

1) Building periphery walk ways bracket distance not
maintained ( distance @ 1mtrs) Rs, 500 per bracket
2) M.s walk ways/working platform not maintained (600mm).
Rs, 500 per M.S walk ways.
3) Walk ways not tied/overlapped (300mm) and tied firmly.
Rs, 500
4) Double guard railing not provided to walk ways bracket
Rs, 500 per railing pipe
3 5) Lift shaft/opening properly not covered/closed. Rs, 1000
6) Not providing safety barricades / barriers to hazardous floor
edge openings,cutout,gaps and shafts Rs, 1000

7) Bracket to bracket breaded net not maintained at existing

floor. Rs, 5000 per pour
8) All fitted safety nets not cleaned / maintained. Rs, 5000
9) Damaged or misuse of the company property. Rs, 5000 (as per material cost)
10) Throwing or falling objects / debris to drop from any heights
of building. Rs, 5000
 Electrical
Adopting unsafe tapping connections and termination of electrical
lines and including the use of defective electrical fittings. Power cables
and electrical tools.
4) Rs, 1000

Allowing cables / equipment to be submerged in water ( use of

defective / low rating cable, without pin top. Ues of plastic for joints /
cut instead of insulation tape)

Machinery-
Failure to provided valid certificates ( third party inspection by
Government competence person ) for all lifting equipments.

Tampering with the safety features of gondola / Winches / Mini crane

5) Rs, 1000
Failure to wear safety harness and anchor to a secure structure , lane
yard, while working on gondola.
Machines moving parts not guarded.
Welding machine kept open while work.
Regarding Vehicles-
Over / high speed driving (above 20km/hrs.) during construction.(Earth
moving and construction equipment)
6) Rs, 1000
Without driving licenses.
Without reverse alarms.
Raiding on earth moving equipment.

7) Child / Underage Worker Find At Working Site- Rs, 10000

Regarding General
Failure to attend a notified site safety meeting.
Failure to attend the Morning Gate meetings.
Failure to provide site safety supervisor / Representative as per the
requirement or manpower.
Threatening safety / personnel misbehaviour / fighting or intentional
8) causing hurt to others. Rs,1000

violating the permit to work system for example.

a) Excavation Work Permit.
b) Confined Space entry permit.
c) Late Night Work Permit.
d) Shaft Work Permit.
e) Sunday / Holiday work permit.
 Daily Night Work Permission Form
DATE
Project :-
Cost Centre :-
Activity :-
Time :- From…………………. Pm To ………………….Pm

Name Of Main Vendor:- Mobile No:-

Name Of Sub Vendor:- Mobile No:-
Staff Present During The Work
Company Staff Vendors Staff
Name:- Name:-
Mobile No:- Mobile No:-
List Of Worker Working At Night
Sr Gat Pass Sr Gat Pass
Name Of Worker Category No Name Of Worker Category No
no no
Vendor Building Engineer Project Manager VP
 NEAR MISS INCIDENT REPORT
Site:- Date

Details of observation or condition at site, With location and time:-

Corrective Action Suggested:-

Corrective Action Taken;-

Verification Done by:-

PM / Site Engineer

REMARKS:-
 MAGARPATTA CITY DEVELOPMENT COMPANY PVT, LTD

FORM THE MONTH OF

Name of the Project:-

Cost Centre:-
Location:-

a) NO OF MAJOR ACCIDENTS

1. Nature of Accident:-

2. Cause Analysis:-

3. Action taken to prevent Recurrence:-

a) NO OF MINOR ACCIDENTS

1. Nature of Accident:-

2. Cause Analysis:-

3. Action taken to prevent Recurrence:-

VP Construction Name & signature of

Date:- Safety Officer

 OHS (SAFETY) VIOLATION NOTICE (NCR)

Project:- Date:-

Cost Centre:- Inspected by:-

1st, Warning 2nd, Warning Penalty

Kind Attention-PM/ACE- Mr
………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………

During the Safety inspection / cheeking at site date……………………………….. Following unsafe act / unsafe
conditions / violation were observed. You are required to rectify / comply within……………………….. Day from
the date of issued notice.

Reason of the Notice:-

Action Required:-

Penalty (Due to above violation) Rs:-

(In words)

Employee / Contractor / Sub-Contractor Acknowledgement-

I Undersigned have received this OHS (Safety) Violation warning letter, and I Understand the content.

Received On:- Name & Signature:-

Safety Dept. PM / ACE VP-Construction VP-Vendor Management

 INTERNAL SURPRISE SAFETY AUDIT REPORT OF
Date:-
Cost Centre:- Auditee:- Auditor:-

Target date
Recommended Corrective action by
SI No. Unsafe Condition Observed the Auditee of Verification of corrective action Remarks
completion

Signature:-
Auditee:- Auditor:- P.M:-

Date:- Date:- Date:-

Rectification done on:-
 First Aid Injury Details
PROJECT & LOCATION Month/year

Treatment
Date & Time Date-Time of injured
Age Body part injured(In given(First corrective Action
S.NO injured(In dd-mm- Vendor's name Injured Person Name Nature of Injury resumed to work(In dd-mm- Root cause Remarks
/Sex detail) aid/Forwarded to taken
yyyy;xx:xx hours) yyyy;xx:xx hours)
Hospital)

Please Select Applicable

Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Please Select Applicable
Root cause
Safety Officer Project Manager
Please Select Applicable Root cause
Not applicable
Adopting improper
work methodology
Defective tools
Electrocution
Failure in design
Failure of tools &
tackles
Failure to implement
work permit

Failure to provide
abreaction
 Failure to provide
edge protection
Failure to provide fall
protection
Failure to provide
slope or shoring
Failure to use fall
protection
Failure to wear eye
protection
Improper access
Rash drive
Run over by
Machinery or vehicle

Unsecured Material
Failure to follow safety
norm
Fall from height
Failure of
Communication
Fall of Material
Caught in Between
Hit by Object
Format No. L009-OHS-FA-Fr-009/Rev01/Oct2013
 Date:-

To,

Sub- Accident Statistics. (Monthly)

Following is the accident statistics monthly from April to March

Month No. of Accident Reportable Accidents