ISGEC / EHS / SP / OCP – 12 / F-20
Rev-04, 28.05.2024
ISGEC HEAVY ENGINEERING LTD
HEIGHT WORK PERMIT
Permit Sr. No Project Name FGD NTPC Kudgi
Job matrix no Unplanned Job matrix no
Section A: To be filled by: Permitee (Contractor Engineer/Isgec Engineer)
Department ________________________ Contractor Name______________________________
Description of work ______________________________________________________
Exact location of work ________________________Elevation ___________ Inside/Outside ________
Job specific TBT given by: _________________________Total no. of workers attended TBT__________
Total no. of workers allowed for work______________
Job specific JSA attached (Yes or No) Job Specific JSA No _________________________
Job Specific Method statement attached (Yes or No) Job Specific Method statement No____________
If working on scaffolding mention below details
Location: Inside/Outside:
Green tag issued by: Green tag number: Valid up to:
Which of the following hazards are associated with this work?
Hazards Yes No Hazards Yes No
Falling objects High winds
Risk of falling persons Overhead electric cables
Unguarded edges Lack of space
Unsecured ladders Uneven floor surfaces
Manual handling of loads Poor illumination
Fragile roofs Uncovered opening
Hand tools provided with tag line Others hazards not listed above
I Permitee, hereby certify that above details are correct & found in order, the adequacy of all Safety
arrangements, Method Statement & Equipment proposed & people competency required for carrying out the
above activity and hereby request permission to proceed with the work.
Permitee’s Name
(Contractor Engineer/ Designation Signature Date Time
Isgec Engineer)
Section B: Permit Issuer (Isgec Area In charge) shall check the following items for compliance before
soliciting the permission
S.No. Description Yes No NA
1 Have all the workers engaged in work are safety inducted
2 Have scaffolds been checked and Green tag ensured
3 Is the hanging basket used for construction tested/Man lifter?
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4 Is the work platform made free of hazards of all traps / trips / slips & fall?
5 Has the edge protection provided against fall from roof Elevated space?
6 Is the area below barricaded?
7 Is Lifeline/Rigid structure available for harness anchoring?
8 Have all the floor openings are closed?
9 Have loose materials removed from all working platforms?
10 Secondary fall protection ensured (Block arrestor, Safety net, etc…
11 TPI for All lifting tools & tackles ensured?
Personal Protective Equipment
Safety appliances Ok Not Ok Remarks Safety appliances Ok Not Ok Remarks
Full body safety harness Hand gloves
Ear plug Safety helmet
Life line Safety shoes
Fall arrestor rope & Clamps Goggles
Any other Any other
Stop work Instructions:
Status: Complied / Not Complied Verified by
I declare the that checkpoints mentioned in checklist is true to best of my knowledge and nothing
concealed therein
Height Work Checklist No._____________________________
Permit issued by ISGEC Area In charge: I Permit Permit verified by ISGEC HSE Engineer: I Permit
Issuer, hereby certify that I have personally visited verifier, hereby declare that above information are cross
the HIGH RISK activity area, satisfied and found in checked and found satisfactory
order, the adequacy of all Safety arrangements,
Method Statement & Equipment proposed & people
competency required for carrying out the above
activity and hereby grant permission to proceed with
the work
Name Sign Name Sign
Date Time Date Time
Section C: Completion (By permitee after completion Section D: Cancellation (By permit issuer after
of work on daily basis) completion of work on daily basis)
I Permitee, declare that the work has been properly I Permit Issuer have inspected the equipment / work
performed and that the equipment, plant & apparatus area and declare that the work defined in this permit is
affected by the work have been left in a safe, clean complete & that the area is clean and safe
condition
Name Sign Name Sign
Date Time Date Time
Note: All the work place hazards and control measures shall be explained to workers in Hindi/local
language before starting the work and Job specific JSA & Method Statement with Tool box talk
copy shall be attached to this permit.
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EHS/SP/OCP-12/F-19
CHECKLIST FOR HEIGHT Rev-04, 30.05.2024
WORK
Name of Project: FGD NTPC Kudgi Work Location:
Height Work Checklist No:
Sub-Contractor: Date: Time: Shift: Day □ / Night □
S.N Description Yes No NA Remarks
1 Whether approved Method Statement for specific work is available?
2 Has Job Safety Analysis (JSA) prepared for working at height as per the method
statement?
All the workers have been explained regarding safe work-procedures, including the specific
3 identified activity for which the PTW is being issued?
Whether Suitable Emergency arrangement including Evacuation system, Ambulance/Emergency
4 vehicle with driver & first aider, is available and kept standby in case of emergency.
5 Whether all workers engaged for work at height are having height Pass?
6 Is required illumination ensured?
7 Workplace inspected prior to start of work?
8 Area below the workplace barricaded?
9 Workmen provided with tool bag / box to carry bolts, nuts and hand tools?
10 Arrangement for tag line /fastening hand tools available?
11 All work platforms are of adequate strength & ergonomically suitable?
Ensured that work at one location/ elevation is not carried out above or below levels, where the
12 activity for which PTW is being issued, to avoid falling of material/tools.
13 Walkways provided with hand-rail / top rail, mid-rail & toe guard?
14 All chequered plates, gratings properly fastened / welded / bolted?
15 All ladders shall be standard make and made of MS/Aluminium/FRP?
16 Are ladders inspected and are maintained in good condition?
17 Are ladders properly secured to prevent slipping, sliding or falling?
18 Are ladders extend 1meter above top of landing and placed at 750 angle at the base?
19 Ladder Rungs not more than 300mm?
20 Proper handrails provided on ramps?
21 Walkways, aisles & all overhead workplaces are cleared of loose material?
22 Area clear from unwanted materials?
23 Platforms and walkways are free from oil / grease or other slippery material?
24 Use of basic and job specific PPE ensured for all?
25 Common lifeline provided wherever linear movement at height is required?
26 Double braided Safety nets are provided?
27 Crawler boards / safety system for work on fragile roof are used?
28 Second line of defence / safety system (Retractable fall arrestor and life line) are provided?
29 Are all the Floor openings covered and barricaded?
30 Adequate warning signs have been displayed?
31 Are the life lines free from any defects and knots?
32 Are vertical lifeline used by only one person at a time?
33 Is lifeline protected from abrasive or sharp edges?
NOTE: Before issuing PTW, Execution Engineer/Supervisor, Site Safety In-charge and shall ensure the above points are checked and complied.
Signature of the Execution Engineer/Area In charge Signature of Site Safety In-charge/ Engineer
Checked by Reviewed By
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