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Crane Work Permit: Permit Receiver & Contractor's Rep. Permit Issuer

This document is a crane work permit that outlines the location, description of work, hazards identified, and precautions to be taken for a crane operation. It requires sign off from the department head, head of health and safety, permit issuer, receiver, and job supervisor to acknowledge the risks and safety measures. Upon completion or cancellation of the work, reasons are noted and signatures collected to close out the permit.

Uploaded by

Akhtar Quddus
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
144 views

Crane Work Permit: Permit Receiver & Contractor's Rep. Permit Issuer

This document is a crane work permit that outlines the location, description of work, hazards identified, and precautions to be taken for a crane operation. It requires sign off from the department head, head of health and safety, permit issuer, receiver, and job supervisor to acknowledge the risks and safety measures. Upon completion or cancellation of the work, reasons are noted and signatures collected to close out the permit.

Uploaded by

Akhtar Quddus
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Crane Work Permit Date: ……………………………………………

Location/Site: …………………………………………………………………………… Permit # ……………………………………….


Area of Work: ……………………………………………………………………………………….. Permit start time:
Description of work: ……………………………………………………………………………... Expected completion time: ………….
……………………………………………………………………………………………………………….. Permit end time: ………………………….
Hazards Identification: Issuance And Acceptance:
S# CHECKLIST YES NO N/A Dept./ Section Head:
1. Crane Fitness Certificate The scope of the work has been explained to the
2. License to operate crane permit acceptor. Job can be started after taking
3. Pulley/Hook/ Chain condition necessary precautions mentioned in this permit.
Name: ……………….. Designation: ………………
4. Sling wire /belt condition
Signature: ………….. Time: ………………………….
5. Eye bolt of Sling rope Head of HSE:
6. Fall from height The scope of the job has been fully understood
7. Objects Falling On Workers and the precautions/isolation and PPEs
8. Lifting height of load mentioned in this permit are sufficient enough to
9. Crane over turned by load execute this job.
Name: ……………….. Designation: ………………
10. Lack of Space for crane
Signature: ………….. Time: …………………………
11. Working Alone
Permit Issuer:
Precautions To Be Taken: After analyzing all the requirements of the job to
be carried out. This permit covers all the
S# CHECKLIST YES NO N/A essentials hence the job can be started.
1. Work Site Inspection Name: ……………….. Designation: ………………
2. Elevated Work Platform Signature: ………….. Time: …………………………
Permit Receiver:
Rope / Safety harness with
3. I have fully understood the specified conditions /
Anchor Point
precautions and I accept the responsibility to
4. Step / Extension Ladder
carry out this job and ensure that all the
5. Safety Signs are present mentioned precautions will be followed by the
6. Isolation of working zone done personnel working under my command.
Potential Hazards Name: ……………….. Designation: ………………
7.
Communicated to Worker(s) Signature: ………….. Time: …………………………
Medically fit Personnel Authorized Job Supervisor:
18.
performing work I have undertaken all the precautions and made
Competent Personnel /confirmed the isolations and other requirements
9.
performing work specified in this permit and I ensure that the
Clear Access and Egress from personnel involved in this job will also follow the
10.
Worksite requirements laid down in this permit .
11. Emergency Standby Team Name: ……………….. Designation: ………………
Others: ……………………………………………………………….. Signature: ………….. Time: …………………………
12. Permit Closure: Signatures:
…………………………………………………………………………….
Permit closed at ……………. Hrs. ………………………..
and returned to the issuer. Permit Receiver &
Job completed. Contractor’s Rep.
job in progress/shift change ……………………………
Job cancelled. Permit Issuer
Reason of cancellation:
Overhead Services/ /Interfering Structure Clearance:
Dept. OH services/structure Name & Sign PPEs & Other Safety Equipment:
Safety Shoes Fire Extinguisher
Safety Helmet Breathing apparatus
Eye protection Spill containment kit
Ear Plug Safety harness
Dust mask Safety net
Distribution: Original - Permit Issuer Face shields Ladder / Scaffold
Card Copy - Permit Receiver/Performer

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