Night Work Permit

PSB DB-03 KARWA NCC-PSB-DB03-DOC-SHE-NWP -01

NIGHT WORK PERMIT

DEPARTMENT : PERMIT NO:

Mr. Date:
1. Permit requested by:(Name of the
A1
Engineer /Supervisor) with Contact Number
Cont. No:
Time (Hrs.):

2. Permit Issuing Authority (NCC PM/ Manager)

3. EHS Verified By (NCC EHS Manager/Officer)

4. Exact Location of Work

5. Brief Description of the work

6. Expected Duration of work during night

7. Date & Time of Starting the Work.

8. Number of persons to be engaged

Driver Name :
9. Emergency vehicle driver name & phone
number.
Phone Number:

10. Project Emergency Contact Number +91 7619413655

A2 Preventive Measures to be taken by Executing agency/Dept.

Preventive Measures Yes No NA Remarks

1 Is suitable weather condition for work?

2 Sufficient Illumination at job place

Safe means to access/egress to job

3
place
Safe working platform with rigid hand
4
rails
Availability of Supervisor with name &
5
Contact number

Availability of Emergency vehicle name

6
& Contact number

Availability and ensuring uses of

7
relevant PPEs
Availability of emergency light in case
8
of black out

1
Night Work Permit
PSB DB-03 KARWA NCC-PSB-DB03-DOC-SHE-NWP -01

We have examined the above precautionary measures taken and found OK to carry out the job safely.

Name & Signature of Line Engineer/Manager: Name & Signature

Engineer/site-in-charge:
(Issuing Authority) (Receiving agency)

Closing /Cancellation of permit:

We hereby confirm that the above work has been completed/ postponed. The area rendered safe & all workers
left the site safely.

Work finished at Date:

Time:

Name & Signature of Contract Agency Engineer/site-in-charge

Name & Signature of Line Engineer/Manager

# Note: - a) Specific work permit like height work permit, excavation permit etc. to be taken along with night
permit
b) The night permit must be taken every day before 4 hours of sunset.
c) The permit must be returned to Safety dept by the issuing authority after completion/cancellation of
the job.

NIGHT WORK PERMIT MUST BE AVAILABLE AT SITE SUPERVISOR OF CONCERNED AGENCY