BEAM / TRUSS/ DUCT/ STRUCTURE FIT-UP & Permit No.

& Date

ALIGNMENT PERMIT
Project & Unit: Emergency Contact Nos
HSEP:12-F12
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.

No. Item Yes Not required /

Remarks
1. Is the alignment procedure & Plan submitted, checked and verified safe (Please attach plan along with drawing,
location & capacities of lifting tools & tackles)
2. Are all lifting tools & tackles, equipment tested and with valid serial numbers traceable to valid certificates
3. Ensured that (for load above 5 Ton) chain pulley blocks will not be used to bear full load of the hanging structure
and will only be used for lateral movement. Either Winches, Leashing, Structural supports or similar arrangement
will be used for hanging the load
4. Ensure that area below is cordoned off and barricaded
5. Ensured that all the workers working on the load (if any): (check whichever is applicable)
a. have double lanyard safety harnesses which are hooked to a lifeline anchored with rigid structure
independent of the hanging load
have retractable fall arrestors, which are hooked to a lifeline anchored with rigid structure independent of the
hanging load
6. Other Permits (Height Work, Hot Work etc. are ensured)
7. All necessary PPEs to be ensured
8. List of associated workers attached
9. Emergency response team & Medical Facilities available.
10. Work hazards are identified, controlled and communicated to the worker in daily Safety pep talk.
11. Method Statements/ Job Safety Analyses attached:
(To be printed on both sides of an A4 Sheet)

12. Other:

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

14. Toolbox Talk Records with (preferably) list of workers involved in the Permit Activity (to be attached)
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 Engineer/ Authorized Representative: Site HSE Officer/ 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

P.T.O. Page 1 of 2
Bharat Heavy Electricals Limited, Power Sector
 Permit No. & Date:
All parameters from S.No. 1 to 14 on Page 1 of this Permit are to be checked physically. In case any deviation is observed, same is to be
rectified, only then work is to be started
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 Remarks
* Officer *
2

10

11

12

13
14

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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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