IVRCL LIMITED, NTPC-SOLAPUR PROJECT

SAFETY DEPARTMENT
HEIGHT WORK PERMIT Permit No.
General Information
Name of Contractor :________________________________________ Date :_____________________
Duration of Work from :________________AM/PM to_______________AM/PM____________________
Nature of work :__________________ ____________________________________________________
Exact Location of work:________________________________________________________________
Name of Persons involved in the work. (Engineer, Supervisor, Foremen)
1. 3.
2. 4.
Total No. of workers :-
The following items must be checked before issuing the permit
Item Y N N Item Y N N
/ /
A A
1. Equipment/ Area inspected. 9. Sound scaffolding with safe access
provided
2. Consider hazards from other routine/ non- 10. Adequate protected platform
routine work operations and concerned provided.
person alerted
3. All persons provided with proper PPE 11. Safety net provided.
4. Are workers briefed about the hazards? 12. Floor opening covered and edge of the
work
platform is barricaded.
5. Power hand tools used at height are 13. Life line is checked and properly fixed
connected through 30mA ELCB. with the structure.
6. Proper lighting provided. 14. Are all the workers trained to work at
height?
7. Area cordoned off. 15. Are all the workers using a dual safety
harness?
8. Precaution against public traffic taken.
Additional permit required and / or attached:- No _ Yes _ ( If yes specify:- )
Daily Visual Inspection
To be signed only after
Signature of Signature of completing the job
Date of Time / Period Remarks
site Engineer HSE Officer Signature of Signature of
work
site Engineer HSE Officer
From To

Special Instructions :
1. This permit must be available at the work site at all times.
2. Location & description of work must be clearly indicated by the permittee.
3. Terms applicable must be clearly indicated by the permittee.
4. All precautions given in permit must be strictly adhered to by the permittee.
5. This permit shall be renewed each day only after checking all the compliance.
6. Permit renewal – for not more than 7 times including the issue date.
7. Permit shall be returned to issuer after completing the job.
TO BE SIGNED BY THE CONTRACTOR AFTER CHECKING FOR THE COMPLIANCE.
All the points mentioned in the above checklist have been checked & found OK

Signature of site Engineer Signature of HSE Officer Signature of Area Incharge

TO BE SIGNED JOINTLY BY CGPL AND CONTRACTOR AFTER THE WORK IS OVER.

Permit is hereby returned after completing the job & ensuring safe removal of men & material.
Signature of site Engineer Signature of HSE Officer Signature of Area Incharge