Permit Number……………

GENERAL WORK PERMIT

(TCPL Green Energy Solutions Private Limited)

Work by: □ Employee □ Supplier (Write name):

Date: Start time: Completion time:
Extension required up to time:
Area of Work & Exact work location:
Permit Owner __________ BUL____________
Permit Owner:
Description of work:

Permit Owner Name: Signature:

* I explained all the safety requirement w.r.t. General work permit and work-related hazard to Permit Acceptor.

BUL:
I reviewed, the area is safe and work can be permitted for above task. I ensure that the all affected employee shall be
communicated of the hazard and precautionary measures.

BUL Name: Signature:

Permit Acceptor:
I ensure the work will be completed under Supervision. I understand the work to be performed and the necessary safety
precautions to complete the work safely as outlined in this permit, method statement and/or risk assessments. If conditions
change to the extent that this permit, the method statement and risk assessments become invalid, it is my responsibility to
stop work immediately and notify the Permit Owner.

Permit Acceptor Name: Signature:

Closing of Permit / Final check

Permit Acceptor:
I declare that the work described above is completed all work equipment, persons and materials under my control have
been withdrawn. All safeguards have been reinstated, Housekeeping is adequately done and the work area returned to a
safe status and service. I also declare that the permit is ready to close.

Permit Acceptor Name: Signature:

Permit Owner:
I formally close the Permit hence all the work done and now area is fully safe from above completed task

Permit Owner Name: Signature:

Job Assessment
Permit Required Permit Number Name of Person Carrying out work Signature
[ ] Hot work
[ ] Work at height > 1.2m
[ ] Excavation
[ ] Confined spaces entry
[ ] Demolition
[ ] Energized electrical

JSA (Job Safety Assessment) Required JSA Done/Attached (Yes / NA)

Verified by Safety Point Leader/Permit
[ ] Machine maintenance / Servicing
Owner
[ ] Chemical Handling
[ ] LOTO Applicability
[ ] Biological hazard Sign: _____________________________
[ ] STF Hazard
[ ] Ergonomics/ Power zone. Name: _____________________________
[ ] Lone workers. Time: ______________________________
[ ] Civil Work.
[ ] Hand Hazard
[ ] Mechanical material handling (Crane/ PIV)
[ ] Manual Material handling. Nos of LOTO Checksheets attached: -
[ ] High Noise (>85 dB)
[ ] Other…………………………

Format No: HSEMS-OCP-01-F-01 Revision No: 01 Revision Date: 25/07/2020

 Activities Sub Activities Hazard Control

Format No: HSEMS-OCP-01-F-01 Revision No: 01 Revision Date: 25/07/2020