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1.daily Work Permit

This document is a daily/weekly work permit that outlines safety procedures for excavation work. It requests information about the contractor, area of work, date and time of work, tools/equipment used, and work description. It also requires preparation steps be taken like protecting surrounding areas, using proper PPE, and providing adequate scaffolding or ladders. Finally, it lists safety precautions that must be followed and provides spaces to approve and issue the permit, as well as potentially extend the permit for additional work.

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Indra
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439 views1 page

1.daily Work Permit

This document is a daily/weekly work permit that outlines safety procedures for excavation work. It requests information about the contractor, area of work, date and time of work, tools/equipment used, and work description. It also requires preparation steps be taken like protecting surrounding areas, using proper PPE, and providing adequate scaffolding or ladders. Finally, it lists safety precautions that must be followed and provides spaces to approve and issue the permit, as well as potentially extend the permit for additional work.

Uploaded by

Indra
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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Date

DAILY/WEEKLY WORK PERMIT JSA No


Permit No

Excavation
Nature of Work(Tick as appropriate) Working on Height Electrical Maintenance Confind Space Entry Rigging Others
work

A REQUEST TEAM

1 Name of the Contractor

2 Area & Location

3 Date and time of work start

4 Date and time of work finish

5 Tools and Equipments involved

6 Description of work

Concerned Contractors Work In-Charge Contarctor Safety Representative


Name
Signature
Date
B PREPARATION C SAFETY PRECAUTIONS (Please Tick)

1 Surrounding Area ,Equipment lines,Cables protected/ covered Yes/No 1 Ensure proper approach arrangement

2 Gas Test Monitored Oxygen Level/Explosive gas level(for confind sapce permit) Yes/No 2 Wear Proper PPE's

3 Following Personel Protective Equipment should be used(Tick the required) Yes/No 3 Wear Full Body harness

a Safety Shoe Yes/No 4 Display Warning Sign Boards


b Helmet Yes/No 5 Ensure Good House Keeping before and after the work
c Full Body Harness Yes/No 6 Ensure proper earthing .
d Hand Gloves Yes/No 7 Ensure proper scaffolding/ladder
e Respiratory Protection Yes/No 8 Barrication of area in case of rigging jobs or excavation works
f Ear Protection Yes/No 9 Using certified lifting Machines and tackles
g Eye Protection Yes/No 10 Checked safe condition of hand tools/ Power tools.

4 Has Electrical clearance been given? Yes/No 11 Ensure the Presence of supervisor during excavation/Execution.
5 Has Double Guard Rail been Provided? Yes/No 12 Life Line is provided for height work
6 Has adequete Working Platform been provided? Yes/No Remarks :-

7 Has safety tag provided? Yes/No


8 Has the Fire Extinguisher(IS:13849) provided? Yes/No
9 Employees aware about hazards and safe working practices while working at height. Yes/No
10 Roof Laddera are in use if working on roof Yes/No
11 Yes/No
D Permit is granted and Valid upto: Permit closing out time :

E PERMIT ISSUD BY: F Permit Extension Date:

Name Date Time From: Time TO:

Name Site Engineer : Sign


Sign

PERMIT RECEIVED BY: Safety Officer: Sign


Number of Workman
Name Date
Check Adequate lighting arrgement for night work All
Sign other above requirements are applicable for extension work.

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