TEPL Green Field Project –JASMINE, Hosur, Tamilnadu
Client: TEL Components Pvt Ltd
PMC: TATA Consulting Engineering Limited
Contractors: KIRBY
PERMIT TO WORK- NIGHT WORK
Permit No:
Section – I GENERAL DETAILS
Project Name
Activity / Type of work
Area / Location
Date : Time From : AM/PM Time To: AM/PM
Permit Applicant Name
Contractor Name No. of Workers Involved :
Section – II PRECAUTIONS TO AVOID POTENTIAL HAZARDS
PRIOR TO COMMENCEMENT YES /NO PRIOR TO COMMENCEMENT YES / NO
The work / activity will not produce High noise level No pneumatic tools and power tools will be
used
The work area is inside the site fencing and security Supervision provided (Client & Contractor)
available full time for restricting unauthorized personnel Name _____________Mob No.
_________ Name
_____________Mob No.________
Safety Coordinator Provided (Contractor) First Aider available (Contractor)
Name ___________Mob No ___ ______ Name _____________Mob No _______
First aid box available, Location ______ Sufficient illumination provided
Required safety controls implemented
Emergency procedure briefed
All workers are equipped with required PPE
All workers are inducted & given Tool Box Talk
Section – III (Permit Requested by):
I request for a permit for the above mentioned work at the location specified above. I have personally inspected the work
place to ensure that requirements needed and precautionary measures as mentioned above have been complied with
Checked by Name Designation Signature
Contractor Site Engineer
Checked by Name Designation Signature
Contractor Site EHS
Authorized by Issuing authority Name Designation Signature
(Area Manager)
Name Designation Signature
Acknowledged by EHS
Section – IV PERMIT CLOSURE
The above job is completed at ----------- am / pm, and ensured all workers and staff left the site safely.
Permit tee (Name)…………………….………Signature: ……………………..Date & Time: ……………………..
The above night work is completed, permit closed & permit submitted to EHS.
Issuing authority (Name): …………………….Signature: ………………………. Date & Time: ……………….…
WP- Night Work
TEPL Green Field Project –JASMINE, Hosur, Tamilnadu
Client: TEL Components Pvt Ltd
PMC: TATA Consulting Engineering Limited
Contractors: KIRBY
WP- Night Work