PRAGATHI CONCEPTS
#108F/9, 6TH CROSS, HGH LAYOUT, NEW AIRPORT ROAD,
GANGA NAGAR, BANGALORE-560032.
HEIGHT WORK PERMIT
Project:……………………………………………….
A: THE PERSON TAKING PERMIT TO FILL UP.
1. EXACT LOCATION WHERE WORK IS BEING PLANNED: ……………………………………………………………………
2. NO OF PERSON INVOLVED: …………………….
3. APPROXIMATE DURATION OF WORK FROM: Date: …………………………
Time: …………………………. To …………………………..
SL POINTS TO CHECK REMARK
NO YES NO NOT
1 All the persons engaged in the work should be well equipped with
necessary PPEs as per the job requirement (Helmet, Full body belt,
Safety shoes, jacket etc )
2 Minimum 20mm diameter polypropylene rope or 8mm wire rope
shall be used as a lifeline.
3 Explain the workers about the requirement of safety equipment to
be used through tool box/ pep talk
4 Fall protection net has been provided all around the periphery of
the building before starting the work
5 Proper access to the work place will be provided by suitable means
before engaging workmen in the work area
6 Suitable platforms have been provided before allowing any
workmen to work at height
7 The housekeeping and illumination of the work area is ensured or
not
8 Materials dropping should be avoided as far as possible. If it is to
be dropped the area below should be barricaded and a watch
person shall be kept
9 Openings in floor – All openings in areas where workmen are liable
to work or pass through shall be closed or barricaded and warning
signage shall be displayed
10 Any other precautions taken
(specify:………………………………………………………………………………………..)
The above points have been complied with and conditions rendered safe/hazards innocuous to undertake height
work.
Name of engineer: ………………………………………….. Signature: …………………………………….
Designation: …………………………………………………..
B) The person giving permit to fill up:
After checking all the above precautions the height work can be carried out in the above area
Name: ………………………………………. Signature: …………………………………..
C) Time: …………………………. Date: ……………………………. At which the permit closed and filed
Signature: ……………………………………..