GENERAL WORK PERMIT

Permit Serial No:

FORMULATIONS
UNIT- BADDI

Date:

Plant:

Block/ Dept.:

Work Planned
From ..Hrs. date
Equipment Used: Portable tools like.

Area / Location:
Activity involved: Equipment / pipe line open up/ Repairing of

To .Hrs. date

Machines / equipment .etc.

1. Description of the Work:

2. Area Hazard identification (Reviewed by the Area Owner / performing Authority who is raising the permit -tick the applicable Hazard)
Fire and
Explosion

Flammable Liquids
/Gases [
]

Health

Hazardous / Toxic
Substances [
]

Mech / Elec
Services

Closed pipeline
or equipment [

Access

* Working at
Height [
]

Environmental

Solid
Waste [

Combustible
Material
[
]
Biological
risks [
]

Flames/ Steam /
High Temp
[
Asbestos.

Steam / Air /
gas lines [ ]
* Confined
Space [

Air / gas release

or emission [

Difficult
Access [
]

Stored energy /
Pressure [
Danger to
Others [

Effluent generation
and disposal [

Noise / Temperature
/ Ventilation. [
]

Moving machinery
/ Control system [
]

Other source of
Ignition.
[

]
]

Chemicals / water
Spillage [
]

Batteries

Manual
Handling

panels/
Batteries

Falling
Objects

GMP

3.Precautions and Preparedness:

( By Permit Initiator / Area Owner & Performing Authority)

Required actions
Y/ N / NA S. No
Required actions
Equipment / Area /pipe line isolated / De-energized
Area is clear and safe from overhead electrical
E
/ de pressurized
lines / any other hazardous lines / Materials
Moving / Rotating machines / Equipment isolated
F
Machines, equipment and portable Tools checked

Work area well illuminated / Ventilated

Aware of Underground Drainage line / pipe/ cable

H
Area barricaded & caution board is displayed
PPEs to be used (Put Tick mark) : Hand gloves PVC Electrical- others / Safety Shoes/ Gum Boots/ Scaffolding / PVC suit / SCBA (Suitable) /
Air mask / Canister mask / Eye Gears/ Face mash/ Face shield / Nose mask, Aprons / Hard hat/ Safety belt/ Step Ladder / Life line,
.any others ..

S. No
A

Y/ N /NA

External /Internal machine operator is skilled

4. Isolations: ( By PI /Area Owner / Performing authority and mechanical /electrical isolation by Engineering /Maintenance / Service floor I/C)
Plant /Service line isolated
and its identification.

Isolation type (Example; Locking off, disconnection)

Temporary Electrical connection required Yes / No

Other precautions if

5. Engineering and Civil Clearance ( By Engineering & Civil Head)

S. No

Required actions

Y/ N/NA

S. No

Equipment / machinery - electrically isolated

No damage in wires / cables

Required actions

Y/ N / NA

No loose wires / cables with free joints

Wires and cables are with 3 pin plug

Mechanical equipment / machines, Tools and
C
Earthing provided
F
tackles are inspected and approved
Assigned Manpower details (If work group is more than 3 members, please use back side)
S. No Work Group Name
Employee / Contractor Skilled / Unskilled / helper
Trained in Safety awareness

Others..

1
2
3
Checked By (Civil, Electrical & Mechanical
/ Service floor Supervisor)

Name

Designation

Signature

Time

Verified By Engineering / Civil Head

6. Permit Approval and Authorization: (Execution HOD & Performing authority)

The area is safe to carry out the work, with the above safety precautions. This work is permitted for execution and shall not be continued if
there is any deviation.
Permit Valid from .hrs. Date .to .hrs. Date.
Name

Designation

Signature

Time

Date

Approved By Execution HOD

Authorized By Performing Authority

Permit Extension: Area Verified and work extended by Execution HOD / Performing Authority
Permit Extended to hrs. Date
..
Permit Extended to hrs. Date
..
Permit Extended to hrs. Date
..
Permit Extended to hrs. Date
..
Permit Extended to hrs. Date
..
Permit Extended to hrs. Date
..
7. Work Completion: The above mentioned job / work is completed / stopped and men are withdrawn, tools cleared, guards replaced. Area handed
over to Area owner at ..hrs. dated ..
Name and Signature
Executor

HES006/F01-00

Civil / Engineering Head

Permit Initiator / Area owner / Performing authority

Note: 1. Raise concerned permit for * if yes (in S. No 2. Area Hazard identification)
2. Permit should be displayed at the Workplace.
3. Permit should be sent to Safety Department after completion of the job.
4. Incase of Emergency alarm/ Siren this permit stands cancelled.
List of activities that requires General work Permit:
1. Lifting / Moving of Equipment / machine / Pipe line / Heavy materials which involves more than
two people.
2. Lifting / Moving of Equipment / machine / Pipe line / Heavy materials which involves lifting
machines.
3. Drainage cleaning
4. Lawn cutting & Mowing operation
5. Bulk Chemicals movement from one location to another location/ loading and unloading.
6. Drums movement from one location to another location/ loading and unloading.
7. False Ceiling work less than 3 meters.
8. Painting work in Process and Service area less than 3 meters.

HES006/F01-00