Permit Number:………………

DEMOLITION WORK PERMIT

(TCPL Green Energy Solutions Private Limited)

Work by: □ Employee □ Supplier (Write name):

Date: Start time: Completion time:
Extension required up to time:
Area of Work & Exact work location:
Permit Owner __________ BUL____________
Permit Owner:
Description of work:

Permit Owner Name: Signature:

* I explained all the safety requirements w.r.t. Demolition work permit and work-related hazards to Permit Acceptor.
Electrical/Civil/IT in charge: (Whosoever is applicable)
I have Inspected area w.r.t Utilities lines, IT & Communication lines, Structural Analysis requirements , the area is safe,
and work can be permitted for above task.

Electrical In-charge: Civil in charge: IT in charge:

BUL:
I reviewed, the area is safe and work can be permitted for above task. I ensure that the all affected employee shall be
communicated of the hazard.

BUL Name: Signature:

Permit Acceptor:
I ensure that the area shall be continuously under supervision from start to completion of the job and all required
displays/ warnings/ indications shall be maintained throughout the job execution period. I understand the Demolition
work to be performed and the necessary safety precautions to complete the work safely as outlined in this permit,
method statement and/or risk assessments. If conditions change to the extent that this permit, the method statement
and risk assessments become invalid, it is my responsibility to stop work immediately and notify the Initiator. The
disposal of any residues of the hazardous materials used will be in accordance with the applicable regulations

Permit Acceptor Name: Signature:

Permit Approver:
I inspected the area is safe w.r.t to demolition work permit requirement and work can be permitted for above task.
Additional Comments: -

Permit Approver Name: Signature:

Sl. No. Name of the Person Carrying out the Work Signature

Closing of Permit / Final check

Permit Acceptor:
I declare that the work described above is complete all work equipment, persons and materials under my control have
been withdrawn. All safeguards have been reinstated, Housekeeping is adequately done and the work area returned to
a safe status and service. I also declare that the permit is ready to close.

Permit Acceptor Name: Signature:

Electrical/Civil/IT in charge: (Whosoever is applicable)

I inspected and verified the area is restored.

Electrical In-charge: Civil in charge: IT in charge:

Permit Owner:
I formally close the Permit hence all the work done and now area is fully safe from above completed task

Permit Owner Name: Signature:

Format No: HSEMS-OCP-01-F-06 Revision No: 01 Issue Date: 25/07/2020

Check the box when an item has been completed. Permit Shall not be issued until following precautions have been checked.

Yes N/A Requirement

Demolition Plan
[ ] [ ] A demolition plan is available on site
[ ] [ ] A method statement prepared by a professional engineer is available.
[ ] [ ] The Supplier, Safety dept, Supervisor and /or personnel directly involved in the demolition works is conversant with how
the demolition works would be carried out? A risk/method assessment has been conducted for proposed demolition
works. Safe Work Procedures indicated in the Risk/Method Assessment has been implemented.
Permit-to-Work
[ ] [ ] A permit-to-work system has been implemented on site.
[ ] [ ] A supervisor & safety assessor has been appointed for the worksite.
[ ] [ ] All persons involved in demolition work have been informed of the hazards and precautions they have to take.
Hoarding, Covered Walkways and Catch Platforms
[ ] [ ] The site is adequately hoarded or barricaded. Measures to prevent unauthorized entry are implemented.
[ ] [ ] Covered walkways or other means of overhead protection are provided. Catch platforms are provided and maintained
where exterior masonry wall or roofs are being demolished.
Preparation for Demolition
[ ] [ ] All glass and cladding to the exterior of the building to be demolished have been removed prior to work commencement.
[ ] [ ] All gas, electric, water, steam and other supply lines have been shut off and capped. If power, water, gas or electric
lines need to be maintained during demolition, such lines have been relocated or adequately protected.
Open side / Openings
[ ] [ ] Open sides or openings where a person is liable to fall more than 1.2 meters are covered or guarded by effective
guardrails, barriers or other equally effective means to prevent fall.
Access and Egress
[ ] [ ] Safe means of access and egress from different levels are provided
Lighting
[ ] [ ] Sufficient and suitable lighting are provided where persons are at work.
Presence of Asbestos
[ ] [ ] Checks are carried out determine if materials to be handled contain asbestos
[ ] [ ] Materials suspected to contain asbestos are sent for analysis.
[ ] [ ] For works involving asbestos, a notification has been sent to authorities (if required) in advance of any such works.
Noise
[ ] [ ] Suitable hearing protectors are provided to all persons exposed to excessive noise.
Personal Protective Equipment
[ ] [ ] Personal protective equipment is provided to persons at work which requires protection, including eye protection, fall
protection, foot protection, hand protection, head protection, hearing protection, respiratory protection.
Debris Accumulation
[ ] [ ] Debris, on the floors, against hoardings or external walls, or at any part of the worksite should not be allowed to
accumulate so as to constitute a hazard.
Debris Disposal
[ ] [ ] Openings used for removal of debris, except the top or working floor, are enclosed from floor to ceiling. If an enclosure
cannot be provided, effective barricades shall be provided at 6m from the openings.
[ ] [ ] A warning notice indicating the hazard of falling debris has been placed.
Demolition of walls, other structure or part of a structure
[ ] [ ] Demolition of walls and partitions in a worksite shall proceed in a systematic manner. All work above each tier of floor
beams has been completed before the removal of its supports.
[ ] [ ] No structure or part of structure which is being demolished are left in such a condition that it may fall or collapse
inadvertently, or be weakened due to wind pressure, vibration or other causes
Manual Demolition
[ ] [ ] Where any demolition work is carried out with the use of hand tools, safe footings in the form of sound flooring or
scaffolds are provided for persons working on an exterior wall
[ ] [ ] Where any demolition work is carried out with the use of hand tools, there are no walls or partitions that are left standing
more than 1 story above the uppermost floor where persons are working.
Mechanical Demolition
[ ] [ ] Where a clamshell bucket is used, a zone of 8 meters of the line of travel of the bucket is maintained.
[ ] [ ] Where other mechanical appliances are used for demolition work, an adequate zone is maintained in the area to ensure
the safety of persons at work.
[ ] [ ] Machines such as excavators and breakers shall descend down to the next floor by means of a ramp. The ramp should
take into consideration the loading imposed
[ ] [ ] Does the work involve any of the following? (Use appropriate permits in addition)
Hot Work [ ] Work at height [ ] Isolation (LOTO) [ ]
Others [ ] (Specify): __________
In the event an emergency, call (Phone): 0657–6131–204/207
and use the alarm box located at ________________________________

Format No: HSEMS-OCP-01-F-06 Revision No: 01 Issue Date: 25/07/2020