HEIGHT WORK PERMIT (For Group Working Only)

Section 1 : To be filled by Contractor/Permit Raiser

Circle :Delhi Cluster :Shivam West Contractor : (Company name, Manager and contact details) Description of the Work to be undertakenCHECKING OF AZUMITH AND TILT

ITL / Corp/ ESH/ F/00/HWP Rev01 Release Date-23/01/2014

Permit Issue Date: Location of Work/Site ID:- 1206 and 5109 (RCOM) 23/01/2014 Company - RELIANCE, Manager Name- Pratap Pundir ,Contact No-9310189078 Tower Erection Tower Dismantling Working on Tower Working on Unprotected Roof Working on Parapet Wall Working adjacent to Excavation Yes Yes Yes Yes
Person should be able to demonstrate: a. PPEs required & their use b. Wearing of PPEs c. Knowledge of Hazards & safe work method associated with work

Persons assigned to task (must be trained in working at heights). Name _ MOHIT 8010560734 Trained Yes Name___________________ Trained Name PREM 7827935652 ___Trained Yes Name___________________ Trained Name _ _____________ Trained Yes Name___________________ Trained Name _ __________ Trained Yes Name___________________ Trained

Section 2 : To be checked by Indus Manager/Engineer

POWER LINES Area must be clear of power lines or power lines must be deenergized SITE CONDITION Access to work adequate Housekeeping acceptable Clear of wild Vegetation growth Free from Nest, Bee Hive Protected Building Edge/Parapet Wall/Excavation TOOLS Approved/Appropriate Tools Tools in Good Condition Tools inspected by competent person in last six month (attach copy of certificate) PERSONAL PROTECTIVE EQUIPMENT The following PPE (tick) shall be worn (must be checked for wear & tear etc): Full Body Harness Eye protection Hand protection Foot protection Protective clothing Safety helmet Other (please specify) FALL PROTECTION Double Lanyard Harness Approved Harness Harness in Dry Condition No part of Harness Missing Harness & its Parts not damaged/defective Lanyard not damaged Harness inspected by competent Person in last six month FALL PREVENTION (For RTT & RTP) Fall Restraint required and available RESTRICTION OF MOVEMENT Barricades provided to restrict the movement under tower Caution Tape provided around tower Caution tape provided around material stocking area EDGE PROTECTION (For RTT & RTP) Barricades provided along building edges to prevent material falling beyond site FITNESS OF PERSONNEL Personnel not suffering from Illness including Cough/Cold Personnel not under influence of alcohol/Heavy Medication Personnel not on Religious Fast (For Tower Work only) COMPETENCE OF PERSONNEL Personnel are trained and experienced in Height Work TOOL BOX SAFETY TALK Dos & Donts General Safety Guidelines PPEs PRECAUTIONS The following precautions have been implemented: Warning notice & Safety Sign provided Emergency Contact Nos.& First Aid box Barricades in position Special precautions are: a) First Aid Trained Person.. b) . c) . d) .

Section 3 : Authorization
I hereby declare that the person identified on this permit is authorized to carry out the work at height subject to the terms and conditions of this permit.The work at height described above is in my opinion in a safe condition for the work to be done, provided that the precautions above are fully observed. Contractor Supervisor/Manager (name) _Sameer Alam______ (signature)______________________________

Indus Manager/Engineer Officer (name) _Snehal Patel__________(signature)______________________________ Permit Period (Valid for 7Days only): Permit is Valid from Date ___23/01/14_to Date __27/01/14_____ Time____________

Section 4 : Certification (to be filled daily by site supervisor)

I agree to work within the conditions indicated on this permit and accept the responsibility as the person directly in charge of the work. I declare that all work at height will be carried out in accordance with the requirements of this Work Permit System. Date Name Signature Date Name Signature ____________ _______________ _________________ ___________ ________________ __________________ ____________ _______________ _________________ ____________ _______________ _________________ ____________ _______________ _________________ ___________ ________________ __________________ ___________ ________________ __________________ ___________ ________________ __________________

Section 5 : Inspection/Compliance (to be filled by person inspecting the Site/ auditing permit compliance)
I have checked the permit compliance and found (Tick the appropriate box): Permit conditions and requirements are fulfilled. Name: Permit conditions and requirements are violated, Hence I have stopped the work & informed the Name: ESH Manager. Sign: Sign: Date: Date

Guidelines for Auditor / Person checking the Permit Compliance: 1. Check Hard Copy of permit. Permit shall be available at site, with supervisor. 2. Check the conditions/requirements mentioned in Section-2 are checked by Permit Issuer. 3. Check Authorization Section (Section-3), signed by Permit Issuer and Permit Raiser. Check permit validity is available. 4. Check Certification Section (Section-4), signed by site supervisor (TSP Supervisor) daily. 5. Inspection/Compliance Section (Section-5): Please tick the appropriate box and provide your initials. (Write your name, date and sign in the space provided)

Date

PTW No.

Indus ID

CM

Work

Name of Permit Raiser (Contractor Name)

Name of Permit Issuer

Cluster / Location

Validity (Days)

Permit start on (Date)

Permit closed on (Date)

23Jan-14

5199

Snehal Patel_9871009304

CHECKING OF AZUMITH AND TILT

reliance

Pratap Pundir

9310189078

Shivam west

23Jan-14

27Jan-14

Dat23Jan14e

1266

CM

CHECKING OF AZUMITH AND TILT

reliance

Pratap Pundir

9310189078

Shivam west

23Jan-14

27Jan-14