WORKING AT HEIGHT
Permit No.___________
Note:
1. To be issued for any work at a height more than 3 meters.
2. Hot work such as cutting /welding /grinding and vessel entry at a height should be done
with a separate ho work /vessel entry permit.
3. Signature of Authorized person means Production In-charge/ Engg. Head.
4. In case of any work on Fragile roof permit to be approved by Unit – Head.
A: (Engineering)
Department/Area :
Details of work :
Permit valid from Date: Time:
To Date: Time:
Name of persons working at height :
Name of standby person /watcher :
CHECKLIST
B: (Engineering)
Done Not Sign
applicable
01. Mention approximate height from the floor feet.
02. Safety harness worn by the person with proper anchorage.
03. Safety goggles, face shield, apron, helmet, gas mask
(As per work requirement)
04. Ensure that scaffolding is mechanically strong.
05. Use safe ladder.
06. Area below the work place condoned & board displayed
07. Ensure that harmful gases are nor expelled out from exhaust /
Ducting near the place of work.
08. Any other instruction. :_________________________________________________
C:
Signature of permit issuer: Signature of Authorized person
Date: Time:
Date: Time: Signature of Safety In-charge:
Date: Time:
All safety instructions have been imparted and we stand to abide the same.
Signature of Contractor
See overleaf SSP:007/00:F1
Validated up to
Signature of Responsible officer
Date Time
D:
1. Scaffolding
dismantled.
2. Caution
boards, cordon removed.
Sign
Job completed on date: Time:
Handed over by: Date: Time:
Accepted by: Date: Time:
SSP:007/00:F1