Blasting Activity Work Permit

Project Name: Location

Contractor Name: Trade

Supervisor Name: Permit No.

BaWP/___________________________

Name of Licensed Blaster NOC available

from Local Yes No
Number of Blasts to be
Authority:
carry out.
Date :
____________ /___________ / 2021

Duration of Permission
Details of Blasting Activity
and Purpose for blasting:
Permit Valid from: am/pm

Permit Valid to: am/pm

Check Points before Blasting Yes No Comments & Action

1 Have the detonators been checked individually for continuity and resistance?

2 Do all the detonators belong to the same manufacturer?

3 Are the explosives and cartridges selected for use the correct size?

4 Are the explosives and detonators of approved quality?

5 Have the condition of lead / leg wires been checked?

6 Are sockets in the blasted area flushed with air and water, and plugged?

7 Have the bore holes been cleared of all the debris before explosives are inserted?

8 Have all the excessive cartridges been removed from the work spot?

9 Have all persons involved in the operation come out of the spot after loading and been counted?

Have the environmental conditions been considered?

10
(Rain / Sunny / Wind / Thunders / Lightning)

11 Are Electronic Items / Radios, mobile phones & pagers prohibited in the location?

12 Is the danger zone suitably cordoned with flagmen posted at important points?

13 Are suitable warning boards displayed at site?

14 Have the number of entry points been identified and access control is established?

15 Is the blaster’s shelter available and in good condition?

Has a proper signaling system been established to prevent trespassers entering the blasting zone, siren or
16
hooter and made available?

17 Are all the drillers provided with Ear Plugs, Helmets, Goggles & Gum Boots?

18 Has a register of record been maintained indicating the following;

i Date & Time of Blast; iii Firing Pattern & Sequence;

ii Number of Holes; iv Type of Explosive Used?

19 Provide the following information on the:

i Quantity of explosive brought to site. Nos

ii Quantity of explosive used. Nos

iii Quantity of explosives returned. Nos

20 Are any Electrical/Telecom line or cables near by? If so specify the distance & Voltage.

21 Has the circuit been checked? Specify the resistance.

CONTRACTOR AUTHORISED PERSON (i.e.Site Eng. / Supervisor) - (PERMIT GENERATOR )

Requesting and confirming by contractor’s representative: I confirm that the precautions specified above is complied with and the persons carrying out the blasting
work are fully briefed on the safe method of work.

Name Signature Date

CONTRACTOR COMPETENT PERSON WITH COLLIERS REPRESENTATIVE (i.e.Site Eng. / Manager) - (PERMIT ISSUER)

Confirmation: I understand and certify that the precautions & safe conditions mentioned above have been verified along with approved SWMS & blasting is permitted

Name Signature Date

Name Signature Date

People shall be evacuated from danger zone & warning sirens shall be blown before the blasting.

V01: 09-11-2021 Page 2 Work Permits.xlsx

Blasting Activity Work Permit
Review of Blasting Activity Yes No COMMENTS & ACTIONS

Has the “All clear” siren been blown?

1
If yes, specify the time of the “All clear” siren. __________________________am/pm

Have any misfires been detected?

2
If yes, give the number of holes:
Actions taken on the above;

CONTRACTOR COMPETENT PERSON WITH COLLIERS REPRESENTATIVE (i.e.Site Eng. / Manager) - (PERMIT ISSUER)
Name Signature Date

Name Signature Date

Note: -
1.The completed permit is to be hanging adjacent to the work being carried out along with copy of SWMS of the activity.
2. The work cannot be allowed, if the permit is not signed from Authorised person.
3. The Permit is valid for one shift / for 8hrs, If the work extends beyond the shift, new permit to be generated.
4. This work permit must be completed by the work supervisor and then be reviewed & signed by a Colliers representative.

V01: 09-11-2021 Page 2 Work Permits.xlsx