DAILY WORK PERMIT

(Issued subject to compliance of all the safety

Precautions mentioned in Safety Checklist)

Location: ___________________ EHS Dept permit No.___________

Initiating Dept.: ______________

I __________________________, the undersigned have explained the method of working to the site
supervisor of the contractor M/S______________________ and have jointly assessed the hazards at
site. Today I have again ensured that all the necessary safety requirements mentioned in the safety
checklist/s are complied with. I hereby grant the permission to carryout today’s prescribed work.

PERMISSION GRANTED FOR (Please tick the appropriate):

1. WORKING ON ASBESTOS CEMENT SHEET ROOF/FRAGILE ROOF – (Refer Safety Card No.1).
2. HOT WORK – (Refer Safety Card No.2).
3. WORKING NEAR LIVE ELECTRICAL LINES (Refer Safety Card No.3)
4. WORKING AT HEIGHT (Refer Safety Card No.4).
5. WORKING ON OR NEAR CRANE & CRANE RAILS. (Refer specific Work Permit and instructions form available )
6. WORKING IN CONFINED SPACE ( Refer specific Work Permit and instructions form )
7. WORK OF EXCAVATION
8. WORK OF GENERAL NATURE

Permit issued Name and signature of Handed over the Permit closed Name &
Signature of the receiver of permit for extension signature of
the daily the work of work the personnel
Date Time work permit permit At To Date Time closing the
issuer Time Sign. permit

1. In case of emergency situation at site the work permit stands cancelled. After normalcy is restored fresh work
permit shall be issued & no work is started unless clearance from the EHS department is obtained.
2. Initiator shall retain the work permit after closing / cancellation of the same for showing to the auditor whenever
demanded.
3. The work permit record to be retained for the period of 6 months.