Adhesive Application Work Permit

PROJECT : Syngene 1401 PERMIT NO:

CLIENT : Syngene International Ltd. DATE & TIME:

PMC : CBRE South Asia Pvt. Ltd.

CONTRACTOR :

PACKAGE :

LOCATION/AREA :

INSPECTION CONDUCTED BY:

The area of work has been examined, precautions checked mentioned below have been taken.
DESCRIPTION YES NO REMARKS
Safety precautions:
Job specific Training for the workers conducted.
The Supervisor must inspect the proposed precautions
taken to prevent fire.
Mandatory PPEs along with Nose Mask, Hand gloves,
safety goggles provided.
Local Exhaust ventilation (not fan) provided and adhesive
vapours are not likely to accumulate in air
MSDS displayed

If adhesive is used, quantity at work place is not above 1

ltrs
Electrical Precaution:
Electrical cables have top plug
Provision of Emergency Lighting
Electrical wire passing nearby is free from joints.
MCB/ELCB in place and checked for proper earthing by
electrician
Precautions near area of work:
No combustible, flammable material near by
Activity watcher:
Dedicated person standing close to activity to watch
He is provided with fire extinguishers
Trained in use of equipment for fire fighting
Additional preventive measure may be added if needed:(Use additional sheet if needed)

I have personally examined the area and certify that precautions have been taken for the above mentioned area.

CBRE South Asia Pvt. Ltd Project Management India Page 1 of 2

Format no: L025-OHS-AAWP-Fr-025/Rev00/Jul2017
 Name & Signature of Name & Signature of
the requesting authority the floor Security

PERMISSION ISSUING AUTHORITY:

Permission issued for this work from ………….… hrs. to ……….…… hrs.

Permit expiry date:

Name & Signature of issuing authority:

Name &Signature of the permittee:

Permit Closure:

Date & Time …………………………………………………………. this permit is closed.

Name & Signature of Permittee.

Name & Signature of issuing authority:

CBRE South Asia Pvt. Ltd Project Management India Page 2 of 2

Format no: L025-OHS-AAWP-Fr-025/Rev00/Jul2017