Permit No.

& Date
RADIATION WORK PERMIT
Project & Unit: Emergency Contact Nos
HSEP:12-F06 Agency:

Exact Location of Work: _________________________________________________________________________________________________

Nature / Description of Work:
Duration of Work Execution *: From Date: to Date: ____Daily from ______________ hrs. to ___________hrs.
Name of Agency Performing the Work:
Name of Agency’s Site Engineer (Permit Requesting Authority): Sign:
Name of Agency’s Package In-charge: Sign: Date:
The above described work will be done under all the safety precautions mentioned on this permit to work as under during the currency of the Permit.
Not required /
No. Item Yes Remarks
1. All the persons at the site informed/removed from the area.
2. Area around the source of radiation cordoned off with the rope/chord.
3. Radiation warning symbol/boards displayed around radiography work on rope/chord.
4. Radiographer worn radiation badges during testing and is within safe limits.
5. Radiography camera and carrying case box having radiation symbol.
6. Radiation Survey Meter is in working condition, calibrated & within validity period.
7. Radiographer has valid certificate from BARC.
8. Blinking light provided on road during radiography (in dark hours).
9. Proper required Illumination provided
10. Safe access and working platform provided to conduct RT work
11. All the persons involved in Radiography work are aware of the hazard of radiation
12. Emergency response team & Medical Facilities available.
13. Work hazards are identified, controlled and communicated to the worker.
14. Method Statements/ Job Safety Analyses attached:

15. Other:

16. List of Other Permits Required for the Activity (Attached):

(To be printed on both sides of an A4 Sheet)

The conditions mentioned in the above checklist are sufficient for safe completion of this activity. These have been checked and found complied before issuing the
Permit, and shall be monitored and ensured throughout the currency of this Permit.
A. Permit Requester/ Receiver (Agency):
Site Engineer: Site HSE Officer:
Signature: Signature:
Name: Designation: Name: Designation:
B. Permit Issuer (BHEL):
Site HSE Officer/ Authorized Representative: Site Engineer/ Authorized Representative:
Signature: Signature:
Name: Designation: Name: Designation:
C. Package-in-charge (BHEL):
Signature:
Name: Designation:
(* Permit valid for 14 days as per overleaf format)
Original: Permittee 2 nd Copy: Agency Deptt. HOS 3rd Copy: BHEL Site HSE

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Bharat Heavy Electricals Limited, Power Sector
 Permit No. & Date:
__________________________
Daily Work Area Condition Endorsement _
Remarks (if any) & Signature with Date & Time
Day Date Agency Site Engineer Agency HSE Officer BHEL Site Engineer * BHEL HSE Officer *
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Permit Extension Beyond Initially Requested Hours

Extension Period Signature with Date & Time
Sl. No. From……. To…… Remarks Agency Site Agency HSE BHEL Site Engineer * BHEL HSE Officer*
(Date, Time) (Date, Time) Engineer Officer
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2
3
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Permit Closure After Work Completion
Permit is here by returned after completing the job, ensuring safe removal of men and material and proper housekeeping of the Area.

Reason for Closure: Job complete Permit Validity Over

Agency
Site Engineer Site HSE Officer
Signature: Signature:
Name: Name:
BHEL
Verified as above and Permit is Closed
In case job not complete, New Permit No. Issued:
Site HSE Officer* Site Engineer*
Signature: Signature:
Name: Name:
(* or authorized representative duly concurred by Region HSE)

Bharat Heavy Electricals Limited, Power Sector Page 2 of 2