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IMS-FR-016 High Height Work Permit

This document is a high height work permit that outlines safety procedures and requirements for working at heights of 2 meters or more. It requires workers to have safety equipment like helmets, ladders, safety belts, goggles, and shoes. The permit must be filled out before starting work and lists the location, description of work, validity period, and safety checks completed. Safety instructions are provided that must be followed, such as immediately reporting any accidents, working under supervision, using certified safety gear, prohibiting smoking or chewing tobacco during work, and following emergency plans. The permit is not valid for night work without additional permissions and safety provisions.

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344 views1 page

IMS-FR-016 High Height Work Permit

This document is a high height work permit that outlines safety procedures and requirements for working at heights of 2 meters or more. It requires workers to have safety equipment like helmets, ladders, safety belts, goggles, and shoes. The permit must be filled out before starting work and lists the location, description of work, validity period, and safety checks completed. Safety instructions are provided that must be followed, such as immediately reporting any accidents, working under supervision, using certified safety gear, prohibiting smoking or chewing tobacco during work, and following emergency plans. The permit is not valid for night work without additional permissions and safety provisions.

Uploaded by

Samsung Networks
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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IMS-FR-016

HIGH HEIGHT WORK PERMIT Ver. No. 02


Date: 10-07-2016

Work Permit Number :


Note : (Circle/SAP ID / HHWP / 15-16/01 onwards)
1. This permit is to be filled before starting of work.
2. This permit is essential in case person has to work on a height of 2 meter ( 6 feet ) or above.

Issued To : …………………………………………………

Supervisors Name,Address & Phone No : …………………………………………………

Name & Sign of Workers : 1……………………. 2……………………… 3……………………..

4……………………. 5……………………… 6……………………..

7……………………. 8……………………… 9………………………


I have been explained the safety instructions in English / Hindi/ Local Language & have fully understood
the safety instructions & will abide with the same. I do not have any hieght phobia.
Location of Work :

Description of Work :

Validity of Permit : From To :


( Date & Time )

Work Completion Date/ Time : (if work continued after the validity of the permit, mention continued.)

( Initiator to Tick mark in the column wherever needed and after checking the necessary
precautionary measures)

Following precautionary measures to be taken Needed Checked Safety check


& Provided

1.Safety Helmet with chin belt provided Chin strap to be firm & helemt to be worn till work completion
2.Ladders of adequate length are provided Ladder locks to be firm, & firmly supported
3.Safety belt with adequate length of life line provided Safety belt to be anchored to a fixed structure
(double lanyard full body harness equipped with shock absorber)
4.Safety shoes provided Shoe lace not to be loose
5.Safety goggle provided Safety goggle to be worn in case of civil work

I have personally inspected the site and I have been explained the safety instructions in
checked the safety requirements & English / Hindi/ Local Language. My staff & I have fully understood
cleared the same for work. the safety instructions & will abide with the same.

Initiator Job Incharge


( Mr………………….) ( Mr………………….)

I have checked the site & issued safety


instructions for high height & cleared the same for work.

Project / Admin Incharge


( Mr………………….)

Below Safety Instructions are to be strictly followed :

1.In case of any accident inform immediately to Supervisor & supervisor must inform repective project incharge (Cluster Head, Admin
Incharge etc. keep the number handy)
2.This work must be carried out under strict supervision.
3.Only the skilled and medically fit competent person with knowledge on use of PPE shall perform the high height job.
4.No tobacco chewing or smoking while working on height.
5. Emergency Management (Rescue plan) guidelines must be followed in case of any emergency
6. THIS WORK PERMIT IS NOT VALID FOR WORKING AT NIGHT, in case of Emergency working at night special written permission and adequate
Lighting provision, safety provision to be provided. WORKING BEYOND 30 KMPH WIND SPEED NOT ALLOWED.
7. Monkey climbing not allowed
8. Full body harness must be ISI Marked / as per EN 361 & IS 3521 Standards

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