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Working Over or Near Water Permit

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191 views2 pages

Working Over or Near Water Permit

Uploaded by

prabhu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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GCC- WORKING OVER OR NEAR WATER PERMIT

STOP! Before starting working over or near water activities review all safety precautions.
Can this work be avoided or is there a safer way, even so, do not authorize work!

Project: Date of issue: Permit number:


General Construction Company
Sub- contractor (Name):
Location (Specific Area Name & Location):

The permit is required for the following situations:


 Any workplace over or near water is considered a dangerous work place, where employees working in such
workplaces are exposed to the hazard of slipping, or falling into the water.

Description of work: EMERGENCY CONTACT NUMBER


(In case of an emergency please call) –
Which of the following hazards are associated with this work? (Check “” which is applicable)
Work over water or silt Unguarded edges

Untrained workers Lack of space

Unstable working platform Exposed Electrical cables

Slip, trip & falls Manual handling of loads

Risk of falling Extreme wind

Additional Hazards (if applicable)

Precautions to be used: (Check “” which is applicable)


Platform with standard edge Harness attached to suitable anchor point

Life buoys are available Lifeline required

Life jacket are available Electrical cables are isolated

Safety watcher/supervisor

Harness with double lanyard

Additional Hazards (if applicable)

GCC-EHSF/WO-NWP/Rev.03_03032022
GCC- WORKING OVER OR NEAR WATER PERMIT
STOP! Before starting working over or near water activities review all safety precautions.
Can this work be avoided or is there a safer way, even so, do not authorize work!

Project: Date of issue: Permit number:


General Construction Company
Sub- contractor (Name):
Location (Specific Area Name & Location):

Mandatory PPE required

1. Performer’s Acknowledgement: 2. Supervisor Acknowledgement:


I understood the work that is to be carried out and will ensure the above I will monitor the work that is to be carried out and will ensure the above mentioned necessary
mentioned necessary safety precautions are followed at all times, I will complete safety precautions are followed at all times, I will complete this task in safe method and I accept

my task in safe method and I accept responsibility for this work. responsibility for this work.
Performer Name: Supervisor Name:
(Permit Receiver) Signature: (Permit Receiver) Signature:
3. Checked and approved by Acknowledgement: 4. EHS Department Acknowledgement:
Authorization is hereby granted for the works as described above. I have checked above control measures and the work area is safe to carry out the activity.
UNSAFE TO WORK
Concerned Engineer Name: SAFE TO WORK
(Permit Issuer)
Signature: Safety officer Name:
Permit Validity Period
From: To: Signature:
(Time):
5. Closed Out:
This is to certify that the works described above have been safely completed / stopped / area has been restored to a safe and orderly condition.
Name: Name:
Concerned Engineer
Signature: Safety officer
(Permit Issuer) Signature:
Closed Out Time:

GCC-EHSF/WO-NWP/Rev.03_03032022

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