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35 Shaft Entry Permit TC

This document is a shaft entry permit that outlines safety requirements and procedures for work inside a shaft or lift well. It includes a checklist of safety precautions that must be verified like scaffolding safety, fall protection, lighting, and safety training. The permit is valid for a specific date and time period and requires inspection and approval from the civil contractor's engineer and safety officer. Upon completion of the work, the permit must be returned to the engineering safety officer.

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MUhammad Rana
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277 views2 pages

35 Shaft Entry Permit TC

This document is a shaft entry permit that outlines safety requirements and procedures for work inside a shaft or lift well. It includes a checklist of safety precautions that must be verified like scaffolding safety, fall protection, lighting, and safety training. The permit is valid for a specific date and time period and requires inspection and approval from the civil contractor's engineer and safety officer. Upon completion of the work, the permit must be returned to the engineering safety officer.

Uploaded by

MUhammad Rana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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Doc. Ref.

EHS-35

Revision 00
Shaft Entry Permit Date 22-05-2018

Location/Project Name: Job No.

Consultant Client :

SECTION 1 - DESCRIPTION / LOCATION

Location :

Description of Work :

Work Permit required for :


(Name of Company)

Work Permit Approved by :


(Name of Company)

Approximate duration of the work :


(incl. Date)
Name of the task incharge / engineer :

SECTION 2 - CHECKLIST

No. Description YES NO NA


1 The scaffolding where the workers want to work is safe?
2 Are the working platform fully planked and planks tied?
3 If the distance between shaft/lift wall and scaffolding is more than 10cm,is there GR?
4 Is there strong overhead protection to prevent material falling on workers?
5 Is there strong fall protection below the working platform?
6 Are the workers in possession of PPE(Including life line and hooking of safety harness?
7 Is there sufficient lighting at the place of work?
8 Is there safe success for workers for entry and exit?(including emergency escape)
9 Is the tool box talks conducted and signed before allowing the workers to enter the shaft?
10 Is the task Supervised?
SECTION 3 - INSPECTION OF Shaft / Lift well AREA FROM CIVIL MAIN CONTRCTOR
The work permit for the above mentioned work at the location specified is issued after personally inspecting
the area to ensure that the precautions mentioned in Section 2 have been complied with.
This is valid from _____________ hours to _______________ hours on date ________________ (1 day only).
(Note: No permit is given for night and Holidays)
Name of Engineer / Supervisor: ______________ Safety Officer Name: _____________

Company: Company:
`
Signature:………………………. Signature:……………………….

SECTION 4 - INSPECTION OF Shaft / Lift well AREA


The work permit for the above mentioned work at the location specified is issued after personally inspecting
the area to ensure that the precautions mentioned in Section 2 have been complied with.

This is valid from _____________ hours to _______________ hours on date ________________ (1 day only).
(Note: No permit is given for night and Holidays)
Name of Engineer / Supervisor: ______________ Tech Engineering Safety Officer Name: _____________

Company: Company:

Signature:………………………. Signature:……………………….

SECTION 5 - CLOSEOUT OF PERMIT


Permit closed

Name of Engineer / Supervisor Sign of Safety officer

Time …………….. hours. Date……………………….


(To be returned to the Safety Officer of Engineering once the work is completed)

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