Height Work Permit

Ref. SOP No.
: AB/SE/015 Page 1 of 2
WOCKHARDT LTD.
H-14/2, M.I.D.C., WALUJ HEIGHT WORK PERMIT
Date: ___________________ Duration of Permit: From______________to______________
1. Originator Department_____________________________________ Equipment Name.________________

2. Work Location: __________________________________________ Equipment No.__________________
3. Description of Work________________________________________________________________________
4. Name of Contract Agency: __________________________________________________________________
A. CHECK POINTS FOR ORIGINATOR DEPARTMENT

Tick Mark√
Y N NA
1. Is workplace free from hazardous dust / fumes?
2. Is the work place clean & accessible to carryout the job?
3. Is the equipment / system made free from operational hazards?
4. Is area below work location cordoned off?
5. Are the emergency exits made known to the persons involved in the work?
6. Are illumination, noise & weather conditions satisfactory to carry out the task?
Instructions If any:_________________________________________________________________________________________
B. CHECK POINTS FOR EXECUTING DEPARTMENT Y N NA

1. Is safe ladder / platform / scaffolding provided?
2. Are the persons deputed for the work fit for the job?
3. Is safety belt / harness is in good condition with anchoring facility?
4. If tools equipments / tools are to be used at height, have been secured against falling from
height.
5. Are persons performing the job detailed about hazards involved in work at height / fragile roof?
6. Are required Personal Protective Equipments/Safety Equipments provided?
Helmet
Safety Shoes
Safety goggles/Face shield/welding shield
Full body harness
Ladder / Scaffolding
Name of Person / s working at height:
Signature of Contractor Supervisor

Remarks:
Sign HOD / Incharge Sign of HOD / Incharge

Originator Department Engg./ Executing Department
Remarks/ Special precautions to be taken (If any)
Name & Signature of Safety Department Representative:
White Copy- At work site Yellow Copy-OHSE Department
Format No. ABSE015-F01-00

Distribution of copies of Work Permit
White Copy: Originator Department Yellow Copy: Safety Department Pink Copy: Security Gate
Ref. SOP No.: AB/SE/015 Page 2 of 2
PERMIT RENEWAL
Date Time Name of Responsible Person /s to be stayed till

completion of job
Renewal Approved / Rejected
Area HOD / Executing Dept. HOD / OHSE Dept. HOD /

Incharge Incharge Representative
WORK COMPLETION CERTIFICATE
1) The above work has been completed / not completed

Handed over by (Executing Dept.): ____________________ Date & Time: ____________________
Taken Over by (Department Incharge):_________________Date & Time: ____________________
Note:
1) This permit normally will be issued in General Shift (i.e. 09:00 Hrs to 17:30 Hrs). If work to be continued
beyond this period, clearance should be taken from all concerned authorities, before expiry of this permit.
2) This permit is valid for the Date/ Time, equipment & area mentioned in permit.
3) Fresh permit shall be obtained everyday.
4) If more than two departments or agencies are involved in the same work, separate permit to be issued to
each department/agency.
5) Signature of all concerned shall be obtained on this permit before commencement of work every day.
6) This permit shall be deemed cancelled if any emergency situation arises.
7) On any working day total working hours of the workers should not exceed than 10 hrs.
8) Workers with a history of any heart alignments / epilepsy should not be allowed to work at a height.
9) After all clear of Emergency, fresh permit shall be obtained to resume the work.
10) This permit shall not be used for Hot work, Vessel/Confined space entry, Excavation, Opening of Hazardous
chemical/pressurized pipe line, and Work on electrical installation. Relevant permit to be obtained for such
jobs.
11) The check point must be complied before start of any activity, not applicable point must be marked as ‘N.A.’
with justification in remark column
12) This permit must be available at work site at all times.
13) Workmen below age of 18 shall not be allowed to work in company premises.
14) Female workmen shall not allowed to work after 19:00 Hrs.
15) If you observe any Emergency situation, call “100”.
Format No. ABSE015-F01-00

Height Work Permit

Uploaded by

Copyright:

Available Formats

Height Work Permit

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Height Work Permit

Uploaded by

Copyright:

Available Formats

Ref. SOP No.

Date: ___ Duration of Permit: Fromto

1. Originator Department_____________________ Equipment Name.

A. CHECK POINTS FOR ORIGINATOR DEPARTMENT

B. CHECK POINTS FOR EXECUTING DEPARTMENT Y N NA

Signature of Contractor Supervisor

Sign HOD / Incharge Sign of HOD / Incharge

Name & Signature of Safety Department Representative:

White Copy- At work site Yellow Copy-OHSE Department

Format No. ABSE015-F01-00

Date Time Name of Responsible Person /s to be stayed till

Renewal Approved / Rejected

Area HOD / Executing Dept. HOD / OHSE Dept. HOD /

WORK COMPLETION CERTIFICATE

1) The above work has been completed / not completed

Format No. ABSE015-F01-00

You might also like