DATWYLER PHARMA PACKAGING INDIA PVT. LTD.

COMPANY NAME :- CANTER ENGINEERS PVT. LTD.

PROJECT :- ELEPHANT PROJECT

No. HEIGHT WORK PERMIT Date:-

Work Start (Date & Time) No. of Workers Location:

PERMIT ISSUE

The below signing person will be responsible to ensure the above described work will be done under all the safety precaution mentioned on the PTW and required by the project.

Sr.No A. Permit requesting Permit Required Location Name Description of Work Time Required Signature
Authority area
Engineer/Supervisor

A.

The following precautions are to be taken .

Sr.No. Descriptions Yes Not Required

1 Scaffolding with valid tag available for use.

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2 Safety Harness checked and in working condition.
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3 Personal PPE's provides are safety goggles, Full body safety belt, safety shoes , hand gloves, dust mask.
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4 All lifting/tightening tools, hand tool/equipment checked and in good condition.
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5 Access and exist marked and without obstruction
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6 Illumination arrangement adequate for night work.
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7 Unwanted and rubbish material removed from working platform
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8 Electrical cable, welding cable, properly secured and lay down without obstruction.
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9 Sign boards provided on working platforms/area.
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10 A Competent engineer/ supervisor in place for supervision.
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11 Employees and workmen are aware about hazards and safe working practices while working at height .
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12 Warning(Barrication) tape/flash light during night provided around the height work.
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13 Protective plastic capes or clothing provided to extended parts of scaffolds.
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14 fire extinguisher provided on working platforms.
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15 Ensure to provide job specific training and Tool Box Talk to all engaged workers before start of the work.
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16 Proper work area housekeeping on daily basis
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17 Other Precautions Required :
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B: Permit request by Area In Charge.
I have verified the Method statement & Risk Assessment and it is suitable . All necessary safety precautions in relation to the hazards identified in the assessment have been taken,.

Area In-charge Name & sign: Date: Time: EH & S Officer sign: Date: Time:

C: Permit Authorized by Client/ Consultant representative Engineer, In-Charge.

Remark :-

In-charge Name: Signature Date: Time:

I understand the precaution to be taken as described above and as per project requirement & here by confirm that work will be executed under my supervision by following all precaution & safety Rules.

Original copy as site office

PERMIT CLOSE
D: Permit Requestor requested for Extension / Closing
I herby declare that all persons under my charge have been Extended / withdrawn and all materials, tools and other equipment have been removed.

Area In-charge sign: Extension Date: Time: EH & S Officer sign: Date: Time:

Area In-charge sign: Closure Date: Time: EH & S Officer sign: Date: Time:

E: Permit Authorized By - Acknowledge the Extension / Closing request

Client/ Consultant representative Engineer In -Charge.

Name (Same in Section C) Extension Signature Date: Time:

Name (Same in Section C) Closure Signature Date: Time: