Work Permit - Working at Height

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WORK PERMIT WORKING AT HEIGHT NWEF 0017 Page 1of 2 Issue B Date 14.02.

2012
Permit No.................... 1. Place of job: 2. Expected time for starting of job: 3. Expected period for completion of job: 4. Job Description: 5. Name of ontractor: !. Name of "#per$isor: %. N#mber of persons engaged: Name of &riginator: Date:.................................

Deptt:

"ign:

'. learance from (nc)arge *+aintenance,: *-./ine0Po1er "#ppl203iring0 abling0&t)ers, "afe Distance from o$er)ead po1er cables: 4emar5s: Name: "ign: 7. learance from (0 "afet2: "r.No. "89E.: -E ;" 0 PPE 4E<=(4E+EN." 01. Temporary Worki g P!atform 02. "uar#rai!s 0$. %#e&uate 'a##ers 04. %#e&uate I!!umi atio s 0(. No )!ippery Foot*ear 0+. ,e!met 07. )afety ,ar ess- Be!t 0.. /ra*! Boar#s-)afety Nets 0For fragi!e roof *orki g1 02. % y ot3er: Date 6 .ime: :es No N.8.

Name: "ign: 1>. ancellation: .)e said job is o$er and read2 for starting t)e prod#ction. &riginator: Name: )ig : (0c "afet2: Name: )ig : (0c +aintenance:Name: )ig :

Date: Date 4 Time: Date 4 Time: Date 4 Time:

(N 8"E &9 E+E4?EN : 8//: 1, "ec#rit2: !>! @ !>% 2, Dispensar2: !>' +onitoring: Depe #i g o te ure of *ork perio#i5a! re6ie* of 5o tro! s3a!! 7e 5arrie# out 7y safety offi5er pro5ess o* er.

ALSTOM T&D
ALSTOM T&D India Limited, P.O. Naini, Allahabad 211 008 (U.P T!l. "#1 $%2 2&# '(22)2( * 2&# '((')(8 * 2&# '&01)% +a, - "#1 $%2 2&# '%0' * 2&# '&0(. ....al/t0m.10m

WORK PERMIT WORKING AT HEIGHT NWEF 0017 Page 2of 2 Issue B Date 14.02.2012

K. Bheemprakash IMS Co-ordinator DT

S.C. Gupta IMS Co-ordinator Sw Gr

K. Razdan IMS Co-ordinator PT

8mendments: Issue % 8 Date# 21.11.0+ 9 :rigi a! issue Issue B9 Date# $0.11.0+ 8 ;o itori g re&uireme t a##e#.

ALSTOM T&D
ALSTOM T&D India Limited, P.O. Naini, Allahabad 211 008 (U.P T!l. "#1 $%2 2&# '(22)2( * 2&# '((')(8 * 2&# '&01)% +a, - "#1 $%2 2&# '%0' * 2&# '&0(. ....al/t0m.10m

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