Height Work PermitHEIGHT WORK PERMITPROJECT NAME:PROJECT CODE:PERMIT NO:DATE:SECTION 1: WORK REQUEST BY CONTRACTOR / PROCESS OWNERPTW RequestorPurpose of height work -Detail of Work location - Approximate time to execute the job from - ____hrs to___hrs on date --/--/----Name - Designation - Telephone number - Identification number -SECTION 2: PRECAUTIONSAttributesYesNoRemarkCompetency & Medical certificates seen and found FITAre all surfaces capable of supporting worker(s) weight(s)?The person(s) will work from a fully completed approved scaffolding or approved man cage?Suitable & safe access and egress available?Is the correct fall arrest equipment available?Fragile areas of roofs identified and marked.Is there a slip hazard associated with height? Detail slip hazard:Are secure anchor point(s) available?Suitable working platform secured and in good condition.Working platform provided with hand rails and toe boards.Tools and tackles are attached with safety slings and secured against fall.Sufficient Illumination available for work?Any simultaneous work at the same location at below levels or not?Whether loose materials at the top of working platform are secured?Worker(s) equipped with full body harness.Safety nets provided?Area below height work cordoned off, entry restricted for unauthorized person and NO ENTRY board is displayed?Ensure that no personnel are there exactly below or in the working zone during lifting of material.Are loose materials removed from erected parts?Whether sling and other tools n tackles are visually inspected by competent person (Mechanical or erection engineer/ trained erection foreman) prior to lifting and are free from any defects?Whether any visual obstruction is there between signal man & crane operator?Availability of first aid boxAny other (Specify)SECTION 3: APPROVALI certify that all the above mentioned safety precautions are ensured at work location.DepartmentsNameIdentification numberSignature & dateExecutionHSE DepartmentPermit start date / timePermit valid until "date / time"SECTION 4: PTW ACCEPTED BYPTW Holder (Work supervisor)NameIdentification numberSignature & dateSECTION 5: PTW CLOSEDI, declare that the mentioned job has been completed satisfactorily. Men and materials have been removed from the work location. Apparatus / equipment are safe for use. Hence PTW hereby closed.PTW Issuing & Closing AuthorityNameIdentification numberSignature & datePTW closed at ------- hrs, Date --/--/--Remarks if any

&LGIL-ORGN-SFT-F-113-01 &C26-JUL-2011&R&P