Conditions of Contract on Safety & Health end Environment, May 2019 f | @ DELHI METRO RAIL CORPORATION LTD. FURM No. : SE/23 PERMIT TO WORK - LIFTING PERMIT ‘SECTION — A: Details of Crew, Crane Configuration & Load Calculation NAME OF CONTRACTOR CONTRACT NO. PERMIT No. Date Time Location, Activity being performed Part - i | Name of Lifting Engineer | Name of Operators: Names of Riggers: [Name of Signal (Bame of Signal man Purt— 2; Crane Details Crane Make, Model & Year: Max. Lifting Capacit Maximum Boom Length: ‘Maximum Radius: | Outrigger full extension (in mtr, Percentage of deratiun in crane capacity: | Automatic Safe Load Indicator: Over Hoist Cut-off Limit Switch: Part —3: Load Details Description of the Load: Lifting points on Load: Rigging Manner of load: Dimension of Load: |Part—4: Load Calculation ( ‘% of Load chart referredifollowed) | a) Crane Roam Length: b)Crane Boom Radius: __, ©) Rope Diameter(mm): | d) No. of falls: + €) Deration in capaci £) Counter weight . h) Weight of Load: ~__sh) Rigging We ) Total Weight to be lift: (SWI. of crane on lifting configur g) SWL (after deration i) Hook Block Wei ) Safety margin in crane capa }) Outriggers extension (in mtrs) _ [Part 5: Receipt 1 (Name of Lifting Engineer) hereby declare that the load calculation as mentioned in Part ~ 4 of this permit shall not exceeds in any circumstances and work shall be carried out in safe manners. In addition, the checklist along with lifting sketches as mentioned in section B of this permit shall be followed and also attached. All measures have been adopted to ensure the stability & rigidity of the cranes as well as rigging. All safety devices of the crane are in proper working order. Section A shall be treated as invalid without | section B. Name: Signed Time Date. Part — 6: Clearance from Safety Department (Name of Safety In-charge) also checked the above load calculation whicl configuration for safe lifting operation. — Load to be lifted), within the erane lifting Name: Signed Time Date‘Conditions of Contract on Safety & Health and Environment, May 2019 ‘SECTION — B: Safety Checklist & Sketeh Part - 7: Safety Measures Checklist ||S | Measures/particulars YesiNo/AviJother No. T | Crane use for lifting is suitable as per site condition and type of | lining _ |[2 [Are lifting crew trained for lifting operation | | 3___| Is crane set up on compacted and firm ground condition (4 ‘Are crane outriggers fully extended and placed on metal plate Are condition of lifting gears free from any type of defects Ts condition of lifting appliance operator cabin in good condition | | | | and wot 0 hi adequate m Is underground utilities presents, if yes, mentioned measures to overcome & crane stability (mentioned in Method Statement) 9 | Is any power cable/OHE cable available, if yes, then measures to | encounter that (mentioned in Method Statement) 10 | Safe means of access arranged 11 _| Safe working platform arranged | [72 | Measures for working at height adopted | 13__| ‘Traffic diversion along with provision of traffic marshal arranged wdraunce Ww any 14 | Ts wind velocity check and under acceptable limit as recommended by manufacturer 15 | Is copy of approved method statement available 16 | Is Automatic Safe Load Indicator working and cut off switch provided & working 7 All certificate & document like TPI. Load chart etc. available 18 _ | Is proper arrangement of illumination done & level of lux maintained 19 | Is rigging done by taking consideration of CG of load w.r.t crane. hook 20 | Swing area of crane properly barricaded 21 | Other sysiem of crane like control lever, fail safe device, boom, winch cte. are in good condition or working properly 22__| Is tag line to control the load is provided “Any other measures Part — 8: Lifting Sketch (this sketch shall be site specific and reflects all hazards/obstruction along with dimension) Consprtium of a Mis Johnson Lifts private Limited, India ‘and Mis SJEC Corporation, ChinaConditions of Contract on Safety & Health and Environment, May 2019 a Part 9 ; Final Authorization | 1(ame of Lifting Engineer) hereby declare thatthe load ealelation as mentioned in Part ~ 4 of section A and measures as mentioned in part 7 of section B shall be ensured. In addition, arrangement for safe lifting, public safety, traffic diversion, working at height, means of access et has been adopted. Name: Signed Part - 10: Clearance from Safety Department. 1 (Name of Safety In-charge) certify that, measures for sae lifting have been adopted at site. Name: Signed PART 11; Clearance Certificate (By Lifting Engineer) 1 declare that all persons under my charge have been withdrawn and wamed that iti no tonger safe ro work at site, | and that ll gear, toos and other equipment have been removed ome Signed Time Date _ _ Part 12 : Cancellation (Being the Authorized Person) | acknowledge receipt ofthe clearance of this Permit This permit is now cancelled Name: Signed Time Date | Ee ‘onsortium of 4 Johnson Lifts Private Limited, India and M/s SJEG. Corporation, China