Edwin A (TMK3)

WORK PERMIT Sep 2023

Description : WORK PERMIT (PTW)

Start Date : 01-Sep-2023 10:00

End Date : 03-Sep-2023 23:30

Category Name :WTP(72) Not Applicable

1. Note down Work Permit Number *

2. Note down Work Permit Start to End date. *

01.09.2023 to 03.09.2023

3. Note down Job Description *

Cm

4. Hazard identification is required? *

Yes No

5. ISOLATIONS REQUIRED *

Yes No NA

6. Electrical base work Fuse to be remove *

Yes No NA

7. Isolator put off & Locked *

Yes No NA
 8. Tested Non-Operative *

Yes No NA

9. Disconnected Batteries connection *

Yes No NA

10. Job Site Checked *

Yes No NA

11. Area Cordoned *

Yes No NA

12. Caution Board Displayed *

Yes No NA

13. ELCB for Portable Tools *

Yes No NA

14. PPE Provided *

Yes No NA

15. Supervision Provided *

Yes No NA

16. First Aid Kit Available *

Yes No NA

17. Electrical Isolation done *

Yes No NA

18. Lock Out Tag Out done *

Yes No NA

19. Are you working in confined space ? *

Yes No

20. O2 Monitoring done *

Yes No NA

21. LEL monitoring Done *

Yes No NA

22. Adequate Ventilation Provided *

Yes No NA

23. Rescuer/ Buddy Available *

Yes No NA

24. Communication Arrangement done *

24. Communication Arrangement done

Yes No NA

25. 24 V Lamp Provided *

Yes No NA

26. Toxic gases checked *

Yes No NA

27. Is your work involve excavation ? *

Yes No NA

28. Underground Cables Checked *

Yes No NA

29. Underground Pipes Checked *

Yes No NA

30. Shoring Arrangement Done *

Yes No NA

31. Intimation to Traffic Police *

Yes No NA

32. Entry & Exit Pit Barricaded *

Yes No NA

33. Portable Light for Night Work *

Yes No NA

34. Ladder Provided and Checked *

Yes No NA

35. Digging Tools Insulated *

Yes No NA

36. Barricading of Work Area *

Yes No NA

37. Ladder Checked *

Yes No NA

38. Scaffold Checked *

Yes No NA

39. Safety Net Installed *

Yes No NA

40. Barricading Below *

 Yes No NA

41. Access Route Cleared *

Yes No NA

42. Arrange to Tie Harness *

Yes No NA

43. Rescuer/Buddy Provided *

Yes No NA

44. Use of Fall Arrestor *

Yes No NA

45. Are you going for any Hot Work ? *

Yes No NA

46. Combustibles Removed *

Yes No NA

47. Sparks Isolated *

Yes No NA

48. Fire Extinguisher Provided *

Yes No NA

49. Fire Fighters Alerted *

Yes No NA

50. Welding Sets Earthed *

Yes No NA

51. Weld cables in good condition *

Yes No NA

52. Adequate Ventilation provided *

Yes No NA

53. Fire Blanket provided *

Yes No NA

54. Are you going to do any heavy material lifting work? *

Yes No

55. Lift Plan available *

Yes No NA

56. Load Test Certificate available *

Yes No NA
57. Lifting Tools & tackles Certified *

Yes No NA

58. Competency of Rigger, Signalman and Operator Checked *

Yes No NA

59. Load calculation done *

Yes No NA

60. No electric/ Overhead power lines *

Yes No NA

61. Guide ropes available *

Yes No NA

62. Weather condition is suitable *

Yes No NA

63. Stability of soil/ platform checked *

Yes No NA

64. Visual inspection check for all the lifting tools and tackles *

Yes No NA

65. Identy hazards from below options- *

High Winds Flammables Explosives

Compressed gas Hot Materials Lifting Machines
Dust Fire

66. Identy hazards from below options- *

Fumes High/Low Pressure High/Low Temp

Live Electrical Overhead Danger Moving Machine
Auto-start equipment Vibration

67. Identy hazards from below options- *

Traffic Confined Space Lack of Oxygen

Use of Ladder Use of Scaffold Unsafe Access
Fragile Roof Lone Work

68. Identy hazards from below options- *

Buried Cables Buried Pipelines HT/LT Line near workplace

Low / No Parapet Wall Heavy Rain Noise
Other (Please Specify): Observation:

69. Select the necessary PPE to be used for job execution *

Safety Helmet Gum Boots Crawling Board

Hand Gloves(Leather) Safety Shoes Hand Gloves (PVC)
Hand Gloves(Electrical) Hand Gloves (Cotton) Safety Goggles
70. Select the necessary PPE to be used for job execution *

Face Shield PVC Overall Dust / Mist Mask

Safety Net Reflective Jacket Ear Plug / Ear Muff
Full Body Harness Fall Arrestor Other(specify)

71. SPECIFIC HAZARDS & CONTROL MEASURES (To be filled by issuing person in consultation with competent person as required
e.g. SL / ZH. (attach separate method statement, if required): *

Yes

72. Note down any other observation comments ,Remark. *

No

Category Name :General(1) Not Applicable

73. Note down any other observation comments ,remark Etc. *

No Issues

Draft Submit