MVML Emergency Contact Nos.

:
Fire Safety Dept.- 7387001598
Mahindra Vehicle
Utility Dept.- 7387094891
Manufacturers General Work Permit
Safety Dept.- 9881103651
Limited-Chakan
Dispensary- 0213561 7171
Contractor’s Contact Nos.:

General Work Permit

(This Permit is valid only for the date of execution)

Area/Location: __________________________________________ Issued on Date: ________ Time: _______

Work Execution Date: _________________ Time Valid From: ______________ To: _________________
Name of user department and name of user dept. Person: ______________________________________
Name of contractor and name of contractor person____________________________________________
Description of work: ________________________________________________________________________

Following precautions are to be taken

Sr. No. Check point Yes / No NR / NA

Ensure that only authorised contractors/employees are permitted to execute the job.
1
Make sure that the safety Induction has been given to the employees.
2
Make sure that the housekeeping in the nearby area is up to date.
3
Make sure that effective supervision is provided on job by the contractor/user.
4
Make sure necessary safety checklists are filled properly and corrective actions taken
5
accordingly.(As applicable)
Make sure that all hand tools, power tools. Electrical cables, connections, joints are in good
6
working condition and free from defects.
Make sure that the job specific personal protective equipment’s are provided and its usage by
7
employees at site.
Ensure that the adequate ventilation and illumination is available/provided at site.
8
Ensure that the work area is cordoned off to avoid unauthorised entry.
9
NR/NA-Not Required/Not Applicable
I understand the precautions to be taken as described above and we here by confirm that work will be executed under my
supervision by adhering all safety precaution & safety rules.

Signature & Signature & Signature & Signature & Signature & Signature & Signature &
Name Name Name Name Name Name Name

MVML user MVML Shop In

Contractor Site In Contractor Site Contractor’s Project Safety
Project Manager dept.-DH and Charge-DH and
Charge Engineer Safety Officer Officer
above above

The above signing person will be responsible and accountable to ensure all safe work practices while executing the activity.

First (Original copy) - MVML-user-DH and above. Second- Contractor site in charge Third- Project Manager
 MVML Emergency Contact Nos.:
Fire Safety Dept.- 7387001598
Mahindra Vehicle
Utility Dept.- 7387094891
Manufacturers General Work Permit
Safety Dept.- 9881103651
Limited-Chakan
Dispensary- 0213561 7171
Contractor’s Contact Nos.:

Permit Extension: If activity is to be carried out after 06:00 pm, take approval from following agencies-
Permit extended from (Time):__________to____________: Date____________

Signature & Name Signature & Name Signature & Name

Contractor Site In Charge Project Manager MVML user dept.-DH and above
If DH is not available after 06:00 pm take
signature of Plant Duty Officer

Permit Cancellation:
I hereby declare that the work is completed/cancelled due to___________________________and all workers under my control
have been withdrawn safely and the shop is restored to a safe tidy condition.

Signature & Name Signature & Name Signature & Name

Contractor Site In Charge Project Manager MVML user dept.-DH and above
If DH is not available after 06:00 pm take
signature of Plant Duty Officer

Format No: SHE/F33, Issue no. 01 dated 15.05.14, Rev. no. 01 dated 22.07.15

First (Original copy) - MVML-user-DH and above. Second- Contractor site in charge Third- Project Manager