Project:

LIS OF IP MPLS Network for Indian Navy (VARUN)

Doc/Rev # STL-VARUN-EHS-M-F10-R0 Ver-1 EHS Manual-Annexure-F10 Permit to Work

F

Name of the Party / Firm Carrying out the work: _________________________________________________

Name of Job in-charge Firm___________________________
Location: Area ________________________________________
Section________________________________
Time of Permit Issue: From _________ Valid Up to__________ If Work Extend: valid up to ____________
Nature of Work (Put √ mark) :
Hot Work Electrical Other work

Safety precautions that need to be taken & special instructions that need to be followed by the contractor carrying out the
work:-.
Other Work
Hot Works Electrical
Working at height Working in Confined Space Construction/Excavation
Flammable materials are Electrical supply is Proper access is being Material incoming supply is Crowbars are properly
isolated isolated / locked provided isolated / locked insulated
Cylinders are kept Earthing is provided Ladder is checked for any Proper ventilations being Provision of adequate shoring
vertical defect provided
Flash Back Arrestor is Cautionary board are Ladder attendant is Hand lamps of 24v to be Electrical supervision of
provided displayed provided provided where proper excavation
illumination is not there.
Connection is checked Proper plug top is Safety belts and helmets Safety belts and helmets are Adequately fenced the
for any leakage provided are provided provided excavated area
Cables are checked for Circuit is checked as per Proper anchoring One attendant is provided Excavated earth to be
any defect diagram arrangements for belts is outside the manhole dumped min 2.0 mtrs away
provided
Fuse rating of welding Supply cables insulation Proper stable platform is Proper stable platform is Scaffolding is stable and free
m/c is checked checked provided with slip provided of any defects
resistant base & support
Fire extinguishing Tools are properly Barricading under the Ladder is checked of any Safety belts and helmets are
equipments are insulated working area defect provided
provided
Gas cylinder regulator & Explanation of the job Sufficient lighting Purging/ flushing/ inerting/
hose pipe condition hazards & safety arrangement for night ventilation space
measures work
Depending on the site condition proper PPE equipments are being used by all the workman
Electrical permit shall be issued in case on Entry at switchyard/Line Isolation/Any test to be conducted
For Hot Work: To be filled by authority issuing the Permit B) Precaution to be taken by Site In charge
A) Precautions to be taken by the Agency 1. Patrolling by site In charge or designated
1. Keep 2 buckets of water near work place person
2. Dowsing of floor by water if required 2. Provide necessary fire extinguisher, if
3. Asbestos / tin sheets around work place to cover required
Hazardous material 3. Others Specify
4. Others, specify

I have fully read and complied with all A permit is hereby issued in view of above As per the conditions of this permit, it is
permit conditions and explained to all and agrees to it. safe to proceed with work.
concerned workmen

Activity In-charge Site In-charge Safety In-charge

It is a mandatory to close the permit after complition of work and return to EHS Department

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