MA/PMC/HSE/SWP-03/Rev_01
MA CONSULTING SERVICES PVT. LTD.
PERMIT TO WORK – LIFTING
Note: 1) Under no circumstances the permitted work should be carried out after the closing time defined in this work permit.
2) Permit should be returned to the initiator on completion of work.
3) This permit is to be issued for defined scope of work and valid for a maximum period of 7days.
Permit No: -
A) DETAILS:
Name of Project Name of Contractor/Agency
Work Location Work Permit Start Date & Time
Scope of Work Work Permit Close Date & Time
B) POINTS TO BE CHECKED AT SITE:
Cont Site in PMC Block In PMC MAN
DATE Cont Safety
Charge charge Safety POWER
1 Cranes/Hydra crane should not be used for side YES/NO/NA
pulls. Only freely suspended load may be side pulled
2 Is Certified rigger medically fit & sufficiently YES/NO/NA
trained?
3 Make sure operator must avoid carrying loads over YES/NO/NA
people.
4 Barricading with display board shall be provided YES/NO/NA
around the Hydra crane & unauthorized entry shall
be restricted inside barricading.
5 Make sure hook have safety latch. The load is well YES/NO/NA
balanced. Avoid tip loading, and loading on hook
latch.
6 Never lift the load over the rated capacity YES/NO/NA
7 Special permission to be obtained from site in YES/NO/NA
charge after considering following guidelines for
8 travelling
Use testedwith suspended
lifting loadof(Try
tool-tackles to avoid by
appropriate YES/NO/NA
capacity (sling / synthetic belt / D-shackle / tailing
hook etc.)
9 Ensure tool box talk shall be given to all Lifting & YES/NO/NA
rigging operations.
10 Ensure that the deployed operator is well trained, YES/NO/NA
licensed, experienced, and competent to operate
the particular Hydra crane to which they are
11 assigned
Do not useonslings,
the particular job
eye bolts, involved.
shackles, or hooks that YES/NO/NA
have been cut, welded, or brazed.
12 Initially lift the load only a few inches to test the YES/NO/NA
rigging and balance Loads should be well secured.
While any employee is touching the load or hook,
13 there shall be no Hoisting, lowering, or traveling. YES/NO/NA
Make sure to complete the entire lifting operations
on during the day light only. If at all to be carried
14 YES/NO/NA
during night hours ensure to provide sufficient
lighting.
Make sure that no worker or any person is allowed
to stay at lifting area. Avoid unauthorized entry. YES/NO/NA
15
(Like Cars, Two wheelers, & pedestrians)
when the load or hook approaches near or over
16 persons, the warning signal shall be sounded YES/NO/NA
If any of the above criteria required is not met, then do not issue the Work Permit
C) AUTHORIZATION:
1 Requestor: I accept the conditions stated on the permit & certify that all persons under my control will be made fully aware of the method statement, aspects/hazards
as well as associated risks/control measures (see attachment).
2 Issuer: I hereby certify that the Checks/ precautionary measures as per Sr.no. B is confirmed. The permit recipient has been informed of all the conditions stated in the
method statement, aspects/hazards as well as associated risks/control measures.
3 Wherever EHS Officer is not available, Site In-Charge will perform the duties of EHS Officer.
4 Should permit not cover the current situation stated then this permit shall be cancelled & a new permit issued.
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MA/PMC/HSE/SWP-03/Rev_01
Contractor Site In charge Contractor Safety Officer PMC Safety Site-In-
PMC Site-In-Charge
(Requestor) (Checked by) Charge (Issuer)
Name/Signature
Mobile No
Date & Time
D) RETURN OF WORK PERMIT AFTER COMPLETION OF JOB:
All work carried out under this permit has been completed on Date: Time:
Contractor Site In charge Contractor Safety Officer PMC Safety Site-In-
PMC Site-In-Charge
(Requestor) (Checked by) Charge (Issuer)
Name/Signature
Mobile No
Date & Time
JSA (Job Safety Analysis)
Sr ACTIVITY
.N HAZARDS IDENTIFIED RISK CONTROL MEASURES RESPONSIBILE PERSON
o (List out the required
(Against each task list the (List the control measures required to (Write the name of the person
task in the sequence
hazards that could cause injury eliminate the risk of injury arising from the responsible (Supervisor (or) Permit
to they are carried
when the task is performed) identified hazards) Holder)
out)
Make sure to check all the laying tools &
tackles with TPI certification.
•Failure of wire rope slings. Make sure to keep people away from the
•Person hit by the material. lifting area.
•Slip, trip & fall hazards.
Make sure only certified & competent
•Hydra crane may topple.
person to operate the hydra crane.
•Unauthorised operations.
Lifting of steel
•Incompetent person for lifting Make sure continuous supervision is
bundles with Hydra Site Engineer/Supervisor. &
1 operations. required.
crane from the trailer concern operators.
•Improper supervision. Make sure to deployed Skilled &
& truck.
•Very poor lighting. experienced workforce for all the lifting
•Not using proper tools. operations
•Unskilled work force.
Check all the lifting tools & tackles before
•No pre inspection of lifting tools
put them into use.
& tackles.
Make sure to use right tool
Provide Proper & sufficient Lighting.
Ensure that all the steel bundles are to be
stacked properly.
Ensure that all the steel bundles are to be
stacked properly.
•Improper stacking of steel.
•Not providing wooden wedges Make sure to provide barricades & signage
Stacking of Steel In-between the steel bundles. boards.
Site Engineer/Supervisor. &
2 Bundles on the •Not providing barricading.
concern operators & workforce.
sleepers. •No proper supervision. Ensure proper Supervision.
•No skilled workers.
•No checklist in use. Deployed only skilled workers.
Follow checklists prior to start the Work.
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