Environment, Health and Safety

Integrated Management System

Tunnel Work Permit IM:10A-1

Part 1 Location: Date:
1. Details of Tunnel Name: Permit no:
Engineer / Shift In charge
– TBM
Sign:
2. Number of persons
involved in work Full list of workmen names must be entered in Page - 2

3. Nature of work carried out Mining/ TBM Maintenance/TBM Services/ Housekeeping

in the tunnel /Communications/Pedestrian access / other works -
4. Precise location of
operation within tunnel
From Ring No…………………….to Ring No…………. or

Location…..………………………………..
5. DPSVB Given Hazards involved:

6. Emergency Measures Alarms / Intercom Telephones / Self Rescuers / Fire Extinguishers &
Hoses / First Aid

Kits/Eye Wash Station / Stretcher / Emergency Exit Signages & Clear

Exit ways
Declaration By Authorized Person:
I hereby declare that the work details on this permit are correct. Hazards associated w.r.t these
activities are briefed to all workmen involved and I do ensure all safety measures while working.

Name : Sign:

Part 2 – by Safety Engineer - Tunnel

This permit is valid from: Time…………………. Hrs to ………………………. Hrs on Date…………………….

Name: Sign:

PERMIT CANCELLATION
Part 3 – by Tunnel Engineer / Shift In charge / EHS Engineer / Authorized Person - Tunnel

I hereby declare that the work details on this permit has been completed or stopped and the area left
safe. All operatives under my control have been withdrawn from the area.

Works must be suspended if conditions of issue were changed.

Name: Sign:

Time: Date:

Sensitivity: LNT Construction Internal Use

 Environment, Health and Safety
Integrated Management System

S. No Name I’D No Signature

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Sensitivity: LNT Construction Internal Use

 Environment, Health and Safety
Integrated Management System

Forenoon:
Description Current % / PPM STEL - LTEL Levels

Oxygen 19% - 23%

H2S 10% - 15%
4.4% - 14% (Explosive
LEL (CH4)
limits)
Results of
CO2 5000PPM -15000PPM
Multiple
Parameters CO 30 PPM – 200PPM
testing Other Gas (Specify) -
Air Flow: Humidity: Temperature:
Illumination: Noise:
Above Testing completed by on ……/… ../……..
at ………. hrs

Afternoon:
Description Current % / PPM STEL - LTEL Levels

Oxygen 19% - 23%

H2S 10% - 15%

4.4% - 14% (Explosive
LEL (CH4)
limits)
Results of CO2 5000PPM -15000PPM
Multiple
Parameters CO 30 PPM – 200PPM
testing
Other Gas (Specify) -
Air Flow: Humidity: Temperature:
Illumination: Noise:
Above Testing completed by on ……/… ../……..
at ………. hrs

Immediately inform Shift EHS In charge/ TBM in charge/ Tunnel Manager if found any limits
exceeding for further decision on evacuation & initiating Emergency Procedures in place.

Sensitivity: LNT Construction Internal Use

 Environment, Health and Safety
Integrated Management System

Additional measures to be checked Yes / No / NA Remarks

Approved Method Statement & Risk Assessment available and
relevant to the task
Daily Pre-Start briefing has conducted
Site supervision is adequately present for different work
locations
Hourly readings from the gas monitors (if alarms observed)
Third Party inspection certificates available for lifting equipment
& gear, pressure vessels

Tunnel Entry system (Tally board) in place and monitored (by

EHS)

Has all the entrants completed Confined space entry training /

Tunnel EHS inducted
Risk assessments & SWM for every activity was available

Underground utilities identified and protected (if required)

Operatives are competent (For MSV, Erector, Cranes)

Does all the entrants were having Proper PPE

Edge protection, warning signposts has been provided at

applicable locations
First Aid Box was available
Trained banksman available (if required for MSV)
Safe Access and Egress is provided
Availability of drinking water facility
Condition of Eye Wash Station
Safety harnesses available (if required for Work at Height in
TBM)
Electrical cables & hoses not interfering with walkways
Dewatering system and in order (if required)
Emergency Response Plan in Place and Briefed to all workers
entering the tunnel
Other applicable permits e.g. Hot Work Permit, Work at Height
permit, Cutter Head Entry Permit Etc (Specify)

 Gas test shall be carried out and results to be recorded every 04 hours throughout the shift

Sensitivity: LNT Construction Internal Use