PERMIT TO OPEN MANHOLE COVERS

A) To be filled in when required to open Manhole Covers/Grills/Guardrails

1. Location of manhole / Grill / Guardrails etc.

2. Permission required to keep Manhole Cover / Grill / Guardrails open

Date: _____________ From hrs. ____________ to hrs. __________

3. Purpose

4. i) Has the area been fenced/cordoned off? Yes/No

ii) Have the red flags (red lights at night) been displayed Yes/No
iii) Has proper illumination been arranged Yes/No

Name : ______________________ Designation : ________________

Signature : _____________ Date : ___________

B) To be filled in by Engineer-incharge / Site-in-charge permitting to open the

manhole cover / grill / Guardrails after ensuring that safety precautions have
been made at the proposed area for opening the cover.

Name : ______________________ Designation : ________________

Signature : _____________ Date : ___________

C) To be filled in and certified by person who had asked for the permission to open
the Manhole Cover / Grill / Guardrails stating that the manhole cover / grill /
Guardrails has been placed back in position properly on _________(date) at
___________hrs after the work was completed and safety arrangements
removed and the area is cleared.

Name : ______________________ Designation : ________________

Signature : _____________ Date : ___________