Dalmia Cement (Bharat) Ltd - Unit:
Excavation Permit
Department: Location: From: To:
This Permit Covers
1) All excavations at one metre and more
2) Road Concrete Breaking
Permit Issued to: __________________ __________________
Name of the Person Name of the Contractor
Description of Work:
Department Clearence:
Electrical Department:
1) Underground electiral cables are passing through the area Y/N
2) Underground Electrical cables at ___________ m depth
Name: Signature
Instrument Department:
1) Underground Inst cables are passing through the area Y/N
2) Underground Inst cables at ___________ m depth
Name: Signature: Time:
IT Department:
1) Underground IT cables are passing through the area Y/N
2) Underground IT cables at ___________ m depth
Name: Signature: Time:
Mech - Utility Department:
1) Underground Pipe Line are passing through the area Y/N
2) Underground Pipe line at ___________ m depth
Name: Signature: Time:
3) Is Energy Isolation Permit obtained?
4)If yes EIP NO & Issued by
Safety Department:
1) Underground Fire Hydrant line are passing through the area Y/N
2) Underground Fire Hydrant line at ___________ m depth
Excavation to be done by Manual: ______ Powered:_________
Other Precautions:
1) Work Area Barricaded Y/N
2) Arrangements made for road diversion Y/N
3) Arrangements made for climbing up & down Ladder____ Steps ____ Others ____
4) Arrangements made for Removing Excess excavated soil. Y/N
5) Arrangements made for shoring/shuttering Y/N
Manual / Mechanical Excavation Permitted
Name: Signature: Time:
Permit Initiator : Permit Approved by HOD Civil:
Emergency Contact number :
Ref. NO Rev No Date:
Dalmia Cement (Bharat) Ltd., - Unit:
CONFINED SPACE ENTRY PERMIT
Time
Location Date FROM TO 2) Hazards / concerns Identified: YES NO 3) Precautions to be Taken: YES NO
1) Description of Job: a) Safe access to work area a) Area provided with suitable access and eg
b) Oxygen deficient atmosphere b) Gas monitoring test Carried out
2) Location of th Job: (Make tick mark) c) Ignition of Flammables c) Space free of Flamable/Combustible Mater
Hoppers Cable Trench d) Corrosives or Irritatives d) Use of appropriate PPE
Silos Kiln e) Excessive Temperature e)Eqpt. Cooled/Forced ventilation facilities
f) All valves/dampers isolated - Process sto
Bag House ESP f) Gas/Vapour or Fumes produced by operation
Mills PH/Cyclones g) Electrocution g) 24 volt supply provided to lights & equip
Tunnel Cooler h) Moving Machinery h) Hazardous Energy Isolation ensured
i) Emergency management / rescue i)Trained Watch person outside confined spa
Name of Contractor:- ______________ Means of communication kept ready (Phone
No. of persons involved: j) Falling Objects j) loose material removed / barrier provided
Names of Personnel involved: Refer back side of permit k) Poor Ventilation k) Proper ventillation facilities provided
l) Poor Illumination l)Adequate Illumination provided
m) Probability of Fire m) Fire Extinguishers availability ensured
n) Others Is Energy Isolation Permit obtained?
If yes EIP NO & Issued by NO: NAME:
Attach list if more persons are involved Please write NA wherever it is Not applicable Signature
Acceptable Present Required PPE: Authorisation & Acceptance: Work Completion / Cancellation
Test Performing Authority: Performing
Helmet Authority:
conditions Reading Shoe I have had the contents of this
Work
permit explained to me and I shall work in accordance with the completed, all persons are withdrawn and material
Oxygen 19 to 21 % Eye Protection
Ear control measures identified removed from the area
Protection Name: Sign: Name:
Combustible gases Below 0 % Sign& Date:
Issuing Authority: Issuing Authority:
Breathing Apparatus
I have ensured that each
Hand Gloves of the identified control measures is suitable and sufficient. The I have inspected the work area and
Carbon Monoxide 0-25 ppm content of this permit has been explained to the holder and work declare the work for which the permit was issued has been
Full Body Harness properly performed
may proceed Name:
Welding Shield Safety Sign: Process Sign: Sign & Date:
Revalidation Coverall suit
I have visited the work area and checked the oxygen level , found it well withen the requirement of this permit and the readings are as follows
Date: Date : Date : Date : Date :
Time interval 09.00Hrs 18.00Hrs 09.00Hrs 18.00Hrs 09.00Hrs 18.00Hrs 09.00Hrs 18.00Hrs 09.00Hrs 18.00Hrs
% of Oxygen level
Safety Authority
Performing authority
Process Authority
Emergency Contact number : Ref. No: Rev No: dt.
Special Instructions:
1) Incase of emergency Siren, all work must be stopped. All personnel must leave work site and proceed to emergenc
2) Incase of fire/huge dust emission , stop work imme
concerned operating personnel.
must be available at work site at all times and permit board to be displayed
Performing Authority should get the permit cancelled by issuing authority.
5) Confined space work permit shall be approved by Safety Manager and Production in-charge
6) Gas test has to be carried out at the time of issue and at every renewal in the day end and next d
Caution:
1) If you have any doubt please contact Section In-charge/plant engineer
2) Do not start work without work permit
3) Use good quality electrical cables, gas hosses & provide proper earthing connections
4) Before starting the work, check all cable & hose joints
Energy Isolation to be carried
Area Date:
out
Feeding Equipment/Chute Dummying, Watch
Extraction Equipment, Air Blaster, De-
Hopper Dusting fan, Fan & Rotary Air Lock Person
Name:
Feeding Equipment, Extraction
Equipment, Aeration System & De-
Silos Dusting Sl. No Name and Token no of personnel working in
Bag Filter Fan, Rotary Air Lock,
Purging, Isolation of I/L & O/L
Bag House Damper(ensuring) 1
Classifier, Feeding Rotary Air Lock/ 2
Tripple Gate, Hot Air Damper in closed
condition, Mill Fan & Main & Auxilary
Drive. Remarks:- For Hot Facing/Mill
Mills, Water Maintenance work, separate SOP to
Pump be followed. As per the SOP No:
Auxillary drive can be run.
Feeding Rotary Air Lock Shutdown,
Shut of Air Blaster in cooler & Kiln
inlet, Main Drive, Auxilary Drive, PA
Fan, Coal Firing Blower, Pre- Heater
Kiln/ Cooler fan, Burner cooling fan, Cooler ESP
Fan, All Cooler fan, Cooler hydraulic
drive 4 nos, Hammer crusher
All Three Transformer, Cooler ESP Fan,
ESP Raping drive, Emitting Drive, Rotary Air
Lock & All Cooler Fans
Rotary Air Lock, Air Blaster, Pre-
PH /Cyclone Heater, Kiln Main & Auxilary Drive
Crusher Feeding Equipment, Extraction
Equipment, Main Drive
Special Remarks if any:
Performing Authority Issuing Authority
rk site and proceed to emergency assembly points.
dust emission , stop work immediatly and inform
3) This permit
4)
nager and Production in-charge (Issuing Authority).
newal in the day end and next day begining.
thing connections
oken no of personnel working inside the confined space:
Dalmia Cement (B) Ltd - Unit:
HEIGHT WORK PERMIT
Time 2) Hazards / concerns Identified: YES NO 3) Precautions to be Taken: YES NO
Location Date FROM TO a) Access to work area a)Suitable access and egress provided
b) Loose materials removed / Safety net
b) Falling of materials
provided / barricade tape & signs placed
1) Nature of Job: c) Over Head Electrical Lines c) Awareness / isolation of power supply
Equipment name:
d) Failure of Crane / other lifting equipment d) Certification of cranes / lifting eqpt. &
tackles by competent person ensured
e)Scaffolds Certified by trained person &
e) Collapse / Failure of scaffolding / Ladders
PERMIT APPLICABLE: 1.5 Mts. & above Ladders visual inspection done
f) Use of Full Body Harness/Anchor points /
f) Fall of person from -height/roof/cable
racks etc. fall arrestors /Safety Nets /Roof walk
Name of the Contractor: ladders/life lines ensured as required
g) Protocol made for lifting operation -
g) Failure in Lifting Operation
No of Persons involved: Trained/certified personnel employed
h) Excessive Temperature to work with h)Adequate protection / shelter arranged
Employees with clear Vertigo Test Certificate alone i) Space made free of flammable / combustible
has to be engaged in Height work activities i) Ignition of Flammables Materials/Barrier provided
Use of make shift arrangements/drums prohibited j) Poor Illumination in night j)Adequate Illumination provided
Is Energy Isolation permit obtained YES/NO k) Emergency management k) Educated on emergency procedures
If yes Energy Isolation Permit NO:
If yes EIP Issued by Name: m)Others
SIGNATURE Please write NA where ever it is not applicable
Required PPE Required Facilities Authorisation & Acceptance: Work Completion / Cancellation
Performing Authority:(Section Engr) Performing Authority:(Section
Safety shoes Engr)
I have had the contents of this permit explained to me and I shall work in accordance Work completed, all persons are withdrawn and material
removed from the area
with the control measures identified Name: Name:
Roof walk ladders
Sign: Issuing Authority: Sign& Date:
Safety Helmet Ladders Issuing
(Section Head) I have ensured that each of the
Authority:(Section Head)
Full body Harness Life lines identified control measures is suitable and sufficient. The content of this permit has been explained to the I have inspected the work area and declare the
holder and work may proceed. work for which the permit was issued has been properly performed
Safety Net Anchor Points Name: Sign: Name: Sign & Date:
Revalidation: I have visited the work area and understand and well comply with the requirements of this permit
Date : Date : Date : Date : Date : Date :
Time Time Time Time Time Time
From To From To From To From To From To From
Schedule
Performing authority
Issuing Authority
Emergency Contact number : Ref No: Rev No: dt.
Special Instructions:
1.Incase of emergency siren, all work must be stopped. All personnel must leave work site
and proceed to emergency assembly points.
2. Incase of fire /huge dust emission stop work immediately and inform concerned
operating personnel.
3. This permit must be available at work site all the times and display permit board
4. This permit has to be revalidated if work has not been started with in two hours of issue.
5. If the permit is not used the issuing person should Cancel the permit
6. Working at height should be avoided in adverse weather conditions.
7. Before starting the work, ensure provision for acess & egress to work at height.
Caution
1. If you have any doubt please contact section in charge/plant engineer
2. Do not start work, with out work permit.
3. Use only tested & certified Safety Harness, net etc.
4.Do not use drums, make shift ladders etc. to reach work at height.
5. Do not smoke in work areas.
6. Use cables for welding earths connection.
7. If you completed the work please follow the following instructions
After completion of work
1. Clean the work area and surroundings.
2. Clean the instruments and eauipments.
3. Keep safety harness, nets, Barricades etc. in proper places.
4. Keep old spare parts and instruments in proper place.
5. Remove loosened things.
Dalmia Cement (B) Ltd - Unit:
HOT WORK PERMIT
Time 2) Hazards / concerns Identified: Yes No 3) Precautions to be Taken: Yes NO
a) Liquid or Gas under pressure / Corrosives or a) After energy isolation, equipment/pipe line fully
Location Date FROM TO Irritatives drained & depressurised/ cleaning of area done
b) Gas/Fumes produced by operation b) All valves/dampers isolated - Process stopped
1) Nature of Job: Welding / Cutting /Grinding /Open c) Presence of combustible /flammable material c) Space free of falmmable/combustible Material
flame
Equipment Name: d) Defective Welding / Gas cutting sets d) Welding / Gas cutting sets checked
e) Danger due to naked flames or arcs e) Space drained free of liquids
f) Welder/cutter exposed to heat/fumes,UV/IR rays f) Wearing of PPE-Welding shield,goggles-ensured
g) Moving Machinery g) Hazardous Energy Isolation ensured
h) Emergency management h) Awareness to emergency procedure ensured
i) Fire during work activity i) Availability of Fire Extinguisher ensured
j) Electric shock to personnel j) Proper elect.connection,Dryness of floor ensured
k) Poor Illumination in night k) Adequate Illumination provided
l) Poor Ventilation l) Proper ventilation facilities provided
m) Falling of Objects m) loose material removed / barrier provided
n) Others n)Fire tender is required on the spot
Is Energy Isolation Permit obtained? YES/NO If yes EIP NO & Issued by NO: Name:
Name of the Contractor: Please write NA wherever it is Not applicable Signature
No of Persons involved:
Required PPE: Authorisation & Acceptance: Performing Work Completion / Cancellation
Authority:(Section Engr) I have had the Performing Authority:(Section Engr)
Helmet
contents of this permit explained to me and I shall work in accordance with the control measures identified
Work completed, all persons are withdrawn and material removed from the area
Shoe Name: Sign:
Name:
Eye
Protection Issuing Authority:(Section Sign& Date:
Ear Head) I have ensured that each of the
Issuing Authority:(Section Head)
Protection I have inspected the work area and
Breathing Apparatus identified control measures is suitable and sufficient. The content of this permit has been explained to the holder and work
declare the work for which the permit was issued has been properly performed
may proceed Name:
Hand Gloves
Full Body Harness Sign: Name: Sign & Date:
Welding
Revalidation
Shield
Coverall suit I have visited the work area and understand and well comply with the requirements of this permit
Date & Time Date & Time Date & Time Date & Time Date & Time Date & Time
Time interval
Performing authority
Issuing Authority
Emergency Contact number :
Ref. NO: Rev No : Date
Hot Work Permit:
Will be required for all works involving the use of a flame or potential ignition sources in the plant.
Activities that may produce or expose a possible source of ignition include, but are not limited to, the
following: Welding / Cutting /Grinding /Open flame
1. Incase of emergency Siren, all work must be stopped. All personnel must leave work site and
proceed to emergency assembly points.
2. Incase of fire /huge dust emission stop work immediately and inform concerned operating
personnel.
3. This permit must be available at work site all the times and permit board to be displayed.
4. This permit has to be revalidated if work has not been started with in two hours of issuing.
5. If the permit is not used, the shift in charge should Cancel the permit
6. Keep one fire extinguisher near the working area.
Caution
1. If you have any doubt please contact shift in charge/plant engineer
2. Do not start work with out work permit.
3. Use good quality electrical cables and gas hoses provided with flash back Arrestor.
4. Before starting the work check all cable & hose joints.
5. Use cables for welding earth connection.
6. Ensure Welding/Grinding/Drilling/Cutting M/Cs.with valid check certificates are only used.
5. Do not smoke in work areas.
On completion of the work please follow the instructions below:
After completion of work
1. Clean the work area and surroundings
2. Clean the instruments and equipments
3. Check for any smouldering fire in the area of work
4. Sprinkle water in the area of work if any elements of fire is suspected
5. Communicate the next shift personnel / security to have a watch over the area for any fire.
Dalmia Cement (B) Ltd - Unit:
General Work Permit
Location: Date: Time:
FROM TO
2) Hazards / concerns Identified: YES NO 3) Precautions to be Taken: YES
1) Equipment Name & Nature of Job: a) Liquid or Gas under pressure a) After energy isolation, equipment/pipe line fully
drained & depressurised/ cleaning of area done
b) Moving Machinery/Electric shock b) Hazardous Energy Isolation ensured
Name of the Contractor: c) Poor Illumination c) Proper Lighting Provided
No of Person involved: d) Poor Ventilation d) Proper Ventilation Provided
e) Falling Objects e) loose material removed / barrier provided
f) Ignition of Flammables f) Space free from flamable / combustible Materials
g) Corrosives or Irritatives g) Cylinders kept away from welding operation
h) Excessive Temperature h)Eqpt Cooled/Forced ventilation facilities provided
i) Gas or Fumes produced by operation i) All valves/dampers isolated - Process stopped
j) Emergency Preparedness of employees j) Workers awareness to emergency proced.ensured
Is Energy Isolation Permit obtained
If Yes, EIP No: Date:
Given by: Signature:
Please write NA where ever not applicable
Required PPE: Authorisation & Acceptance: Work Completion / Cancellation
Helmet Performing Authority:(Section Engr) Performing Authority:(Section Engr)
I have had the contents of this permit explained to me and I Work completed, all persons are withdrawn and material removed from the area
Shoe
shall work in accordance with the control measures identified
Eye Protection Name: Sign: Name: Sign:
Ear Issuing Authority:(Section Head)
Protection Issuing Authority:(Section Head)
Hand Gloves I have ensured that each of the identified control measures is suitable and sufficient.
Full Body The content of this permit has been explained to the holder and work may present I have inspected the work area and declare the work for which the permit was issued has been properly
Harness Name: Sign: performed
Welding Shield
Name: Sign:
Revalidation
I have visited the work area and understand and well comply with the requirements of this permit
Days Date & Time Date & Time Date & Time Date & Time Date & Time Date & Time
Performing
Authority
Section Head
Authority
Emergency Contact number :
Ref. No: Rev No : Date :
a Cement (B) Ltd - Unit:
General Work Permit
NO
Please write NA where ever not applicable
Work Completion / Cancellation
Performing Authority:(Section Engr)
Work completed, all persons are withdrawn and material removed from the area
Name: Sign:
Issuing Authority:(Section Head)
I have inspected the work area and declare the work for which the permit was issued has been properly
performed
Name: Sign:
Date & Time
rgency Contact number :
Date :
Special Instructions:
1. Incase of emergency Siren, all work must be stopped. All personnel must leave work site and proceed to emergency
assembly points.
2. Incase of fire /huge dust emission stop work immediately and inform concerned operating personnel.
3. This permit must be available at work site all the times and permit board to be displayed.
4. This permit has to be revalidated if work has not been started with in two hours of issuing.
5. If the permit is not used the shift in charge should Cancel the permit ..
6. Working at height should be avoided in adverse weather conditions.
Caution
1. If you have any doubt please contact shift in charge/plant engineer
2. Do not start work with out work permit.
3. Use good quality electrical cables and gas hoses provided with flash back Arrestors.
4. Before starting the work check all cable, hose joints.
5. Do not smoke in work areas.
6. Use cables for welding earths.
7. If you completed the work please follow the following instructions
After completion of work
1. Clean the work area and surroundings
2. Clean the instruments and equipments
3. Keep safety nets, Barricades in proper places
4. Keep old spare parts and instruments in proper place.
5. Remove loosened things
ceed to emergency
