Project No.

P-OkiPL1
OKI PULP & PAPER MILL PROJECT
Document No. P-OkiPL1-100-15-FRM-000
[ FORM - OKIPL1] Revision 01
WORK AT HIGHT PERMIT Page 1 of 2
In case of emergency the permit will be considered invalid
Issue Date 20-Oct-16
Permit No.: Permit No.:OKIP2/H&S/PTW/2023/_______ General Permit Reference No.
A Time Schedule
Start Date: Finish Date:
From (hh:mm): To (hh:mm):
≤ Non-working day ≤ Day shift ≤ Night shift
Company Name : __________________________ Permit Holder Name: ___________________________
B Location And Activities
Work Areas / Components of plant:
Excavating
Activities to be executed: 1 3
(to complete work) 2 4
C Measure
C1 Safety Controls as defined in (all documents MUST be attached to the work permit):
Yes No
≤ Job Safety Analysis (Name, doc.no., revision, date)

≤ Underground Services Plan (Name, doc.no., revision,

date)
≤ Other (Name, doc.no., revision, date)
C2 Additional Safety Controls - Prior commence of work Comments & Definitions
≤ Check / search thoroughly for buried services
≤ Hand digging
C3 Additional Safety Controls - During work
≤ Excavation Max. depth
≤ Battering of excavations with : ≤ Timber
≤ Sheeting
≤ Others
≤ Maximum allowable slopes :
Excavations exceeding 2.0 m (slope > 60 degrees)
≤ No eating / no drinking / no smoking inside the controlled area
≤ Hard barricading at the edge
≤ Fall protection
≤ Soft Barricading in a distance > 2 m to the edge
≤ Piling of equipment and soil (distance at least 0.6 m to the edge)
≤ Distance of cranes, vehicles, equipment at least 1 m to the edge
≤ Distance of heavy cranes, vehicles, equipment (> 12 tonnes) at least 2 m to the edge

C4. Additional Safety Controls - Emergency Rescue Plan

1. PIC
Emergency Contact Number 2. Shift Leader
3. Health & Safety
≤ Restore work area to normal condition
≤ Clean hands and face after leaving the controlled area
C5. Additional Safety Controls - After work
1.
2.
3.
4.
5.