FOURTH DIMENSION ARCHITECTS PVT. LTD.

CIVIL/CONSTRUCTION/EXCAVATION WORK PERMIT

Constractor is solely responsible for the work permit & implementation

WORK PERMIT IS VALID ONLY FROM 09:00 A.M TO 18:00 HRS
Work permit valid issue Date :
Plant and location : Permit issued by Department :
Permit issued to contractor :
WORK No. of MP LOCATION SUPERVISOR NAME/ CONTACT NO.

Job to be carried out :

3

Equipment to be used :

CIVIL/CONSTRUCTION/EXCAVATION work permit - Checkpoint :

Sr.no: Check Point Remarks YES/NO/NA Sr. no Check point Remarks YES/NO/NA

1 ls the exact route of excavation told to all the people working 8 information about hazard is given
to persons working .
2 All equipment s used for excavation are inspected. 9 All trenches and excavated pits
are hard barricaded , caution
board are displayed .
3 Before excavation, barricading plan should be available . 10 Heavy machinery/equipment s
movement is avoided near
trenches/excavation
4 Underground electrical cable layout is available . Name of attendant is provided Mr.
11
during course of work .
12 Personal protective equipment required :
5 safety helmet are provided &
12.1
Electrical cable/pipeline flow is shut off before excavation . ensured its use
safety shoes are provided &
12.2 ensured its use.
6 Pipe line layout is available and given to persons working .
7 Underground electrical cable & Pipeline are marked on the route Job specific PPE s must be used
of excavation . 12.3
Hand glove ; Goggle , Nose mask
and earplug .
Declaration : I agree to work within the conditions indicated on this permit & accept the responsibility as the person directly in charge of the work . I declare that all work at site will be carried with proper supervision
and ensure all safety precuation at site.

Name of the site incharge/engineer :- Sign:- Date: -

Time Name Signature
Contractor Eng. Dept
Work assignment

Contractor EHS dept.

PMC Eng. Dept.

PMC EHS Dept.

Infiiloom Project Dept.

Infiiloom EHS Dept.

Time
Date Contractor Eng & EHS Dept Sign PMC Eng. & EHS Dept Sign Infiiloom Project & EHS Dept Sign
Extention work permit

From To

Remarks:-

Date & Time Signature

Closer of work

Contractor Eng & EHS Dept Sign

permit

PMC Eng. & EHS Dept Sign

Infiiloom Project & EHS Dept Sign

Important safety instruction must be implemented / adhered by contractor

1.supervisior should available at site all the time 5.Ensure easy access at site .
2.Ensure housekeeping after completion of work at site
6.Ensure good crossing bridge provided to cross the excavated area .
3.Ensure use of required PPE s while doing job . 7.Play attention to work while working in crowdy area .

4. Barricade the area from all site . 8.Display cautionary boards for safety and emergency .