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Permit For Working at Height

This document is a permit for working at heights issued by Nokia Siemens Networks to an employee. It lists the permit number, dates of validity, site details, description of work, associated hazards, and control measures to be implemented. The control measures section contains a checklist to ensure things like authorization, training, risk assessment, use of safety equipment, safe access, and emergency contacts. The permit must be signed by the receiver and issuer to confirm the work has been understood and all precautions will be followed.

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Mohit Bhadauria
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1K views

Permit For Working at Height

This document is a permit for working at heights issued by Nokia Siemens Networks to an employee. It lists the permit number, dates of validity, site details, description of work, associated hazards, and control measures to be implemented. The control measures section contains a checklist to ensure things like authorization, training, risk assessment, use of safety equipment, safe access, and emergency contacts. The permit must be signed by the receiver and issuer to confirm the work has been understood and all precautions will be followed.

Uploaded by

Mohit Bhadauria
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Nokia Siemens Networks

Country & Business India, Global Services


No. & Concerns : F-01 (OCP-003) & Permit for Working at Height
Rev. No. & Issue Date 00 & 01.06.10

1. PERMIT NO:
Valid From (Date/Time): Valid Upto (Date/Time):

2. Site ID/Site Detail/ Location of Work:

3. DESCRIPTION OF WORK TO BE CARRIED OUT:

4. HAZARDS ASSOCIATED WITH THIS WORK (Please Identify using HIRA)

5. CONTROL MEASURES TO BE IMPLEMENTED

S.N ITEM Yes No Remarks


1 Is the person authorised, competent & trained to work at
height
2 Is the scope of work to be carried out at height is known
and understood.
3 Risk assessment conducted/ Risk evaluated
4 Double lanyard full body Safety harness secured to a
fixed structure / strong anchoring point. All other PPE as
required is being used.
5 Safety net available/ Steel scaffolding / platform rightly
erected / is being used. ( Only for Project Management
Scope i.e. supervision)
6 Safe access to work place / working platform with
handrails and toe guard provided.
7 Is the area cordoned off/barricaded
8 Nearest Emergency Contact Detail available with team.
9 Is energy Isolation required
10 Adequate lighting and all requirements for night working
procedures followed and provided.
11 Is activity being carried out in the presence of a NSN
engineer or the presence of supervisor required?

6. ENDORSEMENT
I have understood the nature and extent of the work. I agree to comply with all safety precautions
Name Signature Date Time
Permit Receiver
Permit Issuer
Completion of Work: (All safeguards returned to normal/Any other Feedback/Comments :

Issuer Signature & Name

Page-1 Document Owner & Department Controlled


Services OHS Department

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