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Height Work Permit

The document is a Height Work Permit form used by CtrlS Datacenter Limited, detailing the necessary safety checks and equipment validation required before commencing work at height. It includes sections for listing equipment, confirming safety measures, and obtaining signatures from relevant authorities. The permit must be kept on-site and is specific to the individual it is issued to, with protocols for cancellation and re-issuance if work is transferred to another person.

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kutty Joshva
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38 views1 page

Height Work Permit

The document is a Height Work Permit form used by CtrlS Datacenter Limited, detailing the necessary safety checks and equipment validation required before commencing work at height. It includes sections for listing equipment, confirming safety measures, and obtaining signatures from relevant authorities. The permit must be kept on-site and is specific to the individual it is issued to, with protocols for cancellation and re-issuance if work is transferred to another person.

Uploaded by

kutty Joshva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CtrlS Datacenter Limited.

CtrlS/PROJECT/SOP/14/F04
HEIGHT WORK PERMIT Permit
SL.NO.
To be filled in by Job Supervisor/ Engineer
Permit Issued To:- Permit Issue Exact
Date:- Location:-
Work Details:-

Validation of Work Permit. From Time AM / PM To Time AM / PM


A List out the Name of Equipment's used for Work. Checked safe condition of hand tools/ Power tools
Checked
Sr.No. Name of Equipment's Remark :-
Yes / No
1

6
Note:- If Equipment is more than the list please attached separate list.
B Control Measures to be ensured perior to start the work ( Please tick mark on applicable Columns)

Sr.No. Safety Checks for compliance YES NO N/A

1. Safety Induction given to all employees & workers before employing.


2. Scaffolding checked with valid tag available for use.
3. General instruction about the work / TBT.
4. Personal Protective Equipment used as per Job Requirements
5. All lifting / tightening tools, hand tools /equipment checked and in good condition.
6. Access and exist marked and without obstruction. (Ladder If required)
7. Adequate Lighting arrangement and Provision of Emergency Light
8. Area has been Isolated, Signboards provided for Hazards Communication.

9. All workmen working at height having full body safety harness is provided, use shall be ensured
10. Safe Scaffold/work platform with proper guarding/railing provided
11. Fall arrester and lifeline rope, safety net provided wherever applicable
12. No loose materials at higher elevation
13. Qualified, experienced, trained & skilled supervision exists for the activity
14. Electrical cable/ welding hose / compressed air hose properly secured and lay down without
obstruction.
15. Availability of Rescue arrangement
16. Others …………………..
I hereby declare that I have understood the work methodology, hazard/risk associated with the activity. I have checked and ensured that all
Acceptan control measures as stated above are in place. I take the responsibility to complete the work safely.
ce:
Performing Authority Signature Date & Time Remark
Job Supervisor:
Contractor PM/CM:
Contractor EHS:
I hereby authorize the work specified above to the time specified and confirm that safety arrangement stated above are
Permit Issuing Authority : enough to prevent any harm or incident.
Permit Issuer Name Signature Date Remark
Issuing Authority (CTRLS)
EHSO (CTLRS)
The work as stated above has been completed. Man and machines have been
Closer of
Removed. Housekeeping around the work area has been done. Hence, work permit is Signature: Date: Time:
Permit. closed and Submitted to Ctrls EHS Department. (Job Supervisor/ Engineer/ Signature-Performing Authority)
1. This permit Applies only to work in the location described. This permit is to be kept on work location and should show on demand.
Note : 2. This permit only applies to the person to whom it is issued. If work has to be continued by someone else, this permit must be returned to issuer for cancellation
And another permit issued.

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