EHS-WP-05 Height Work Permit

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ROHAN BUILDERS (I) PVT.LTD.

Project-.
HEIGHTWORK PERMIT
Sr. No: _________________

Note:1) Please tick or Circle wherever applicable

Date and Time of Permit Issue:


Permit Start Time: Permit End time:
Nature of Job:__________________________________________/ OtherLocation:

Job Description:

Equipment: -

Probable Hazards; a) Fall Hazards.a) Building Structures b) Exterior Construction Areas c) Scaffolds
d) Staircase .e) Ladders

Checklist for Originating Department

Sr. Check Points Yes No NA

1. User dept.to ensures the competency and experience of the


contractor/employee and his team to Execute the height work job.
2. Ensure that the employees have gone through the safety induction program
and are well aware of the hazards associated with the height work activities
3. Ensure that the tool box talk is given every time before start of the height
work activity
Ensure that the following PPE’s are mandatory while working at height-1.
4. SAFETY HELMET 2. SAFETY HARNESS.3. REFLECTIVE JACKET.4.
USE OF LIFE LINE.5. SAFETY SHOES

5. Ensure that the anchoring points are available to fix the life line

6. Ensure that the area nearby and below is cordoned off and barricaded with
signage’s.
Type of access used to reach to work station- (Tick as applicable)
1.FIXED/MOBILE SCAFFOLD 2. LADDERS.3.CHERRY PICKER 4.
7. SEIZER LIFT 5. VERTICAL FALL ARRESTER
Ensure that all the equipment’s as mentioned above are in good working
Condition and health tag is provided on the equipment’s.
8. Safe Access & Egress provided

9. User dept.to ensure the competency and experience of the


contractor/employee and his team to Execute the height work job.
10. Ensure that the employees have gone through the safety induction program
and are well aware of the hazards associated with the height work activities
11 Ensure that the tool box talk is given every time before start of the height
work activity
Ensure that the following material & devices inspected for use working at
12
height (Safety Belt, Ladder, Scaffolding, Fall arrestor etc.)

Work clearance from all concern departments are verified & found
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satisfactory.

14 The work has been discussed with the person in charge and all quality,
safety and environmental precautions considered. controls will be in place
ROHAN BUILDERS (I) PVT.LTD.
prior to commencement.

NR/NA-Not Required/Not Applicable.


 I understand the precautions to be taken as described above and we here by confirm that
work will be executed under my supervision by adhering all safety precaution & safety
rules.
Name & Signature of RBIPL Name & Signature of RBIPL Name & Signature of RBIPL

Site Engineer/ Supervisor Safety Officer/ Supervisor Project Manager

The above signatories will be accountable to ensure safe and eco-friendly work practices while
executing the said activity.
 Work Permit Approval By: PMC/Client :

Name & Signature of Name & Signature of Name & Signature of


PMC/Client PMC/Client PMC/Client

Site Engineer Safety Officer Project Manager

Work Permit completion/suspension/extension

 Permit Extension/ Renewal for the same day during night work:
Date: ____________ Time: From ________________To______________________

Name & Signature of RBIPL Name & Signature of RBIPL Name & Signature of RBIPL

Site Engineer/ Supervisor Safety Officer/ Supervisor Project Manager

Above signatories are accountable for work completion/suspension or extension of permit.

 Permit Extension By: PMC /Client:


Name & Signature of Name & Signature of Name & Signature of
PMC /Client PMC/Client PMC/Client

Site Engineer Safety Officer Project Manager

Note: - After closing the permit it shall be submitted to safety department.


ROHAN BUILDERS (I) PVT.LTD.

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