Updated PDG Ind Ohsmsm 1304 Permit To Work

PRINCETON DIGITAL GROUP
Permit To Work
1.0 PURPOSE
The purpose of this procedure is to protect every individual on site by means of a permit-to-work system in
conjunction with specific work procedures and safe practices. All work which is under the control of the permit-
to-work system shall be carried out strictly in accordance with the requirements and conditions included in
the specific work permits.
Work permit system is dovetailed around custodian concept. The DC Head is custodian of the project and all
work in that functional area shall have authorization.
2.0 SCOPE & FIELD OF APPLICATION
This standard is applicable across PDG DC projects in India. Permit to work shall be applicable to (but not
limited to) all works that are required to be carried out within PDG DC project works carried out by vendors/
contractors under PDG supervision etc. based on the following guidelines:
• The “permit-to-work” system will in principle cover all on-site routine and non-routine work
which may create potential hazards.
• All activities shall necessarily need to have work permit unless and otherwise it is stated
and approved by Issuer.
• A list of activities where general work permit is not required will be prepared and approved
from Issuer.
• A permit-to-work is an essential part of Safety Management which provides a carefully

planned system of safety checks and authorizations prior to carrying out actual work.
• It is cautioned that permit-to-work is not permission to carry out a dangerous job. The permit-
to-work system should not be regarded as a way of avoiding the need to eliminate hazards
and reduce risks.
• The issue of work permits does not, by itself, make a job safe or guarantee safety. The
conditions and safety precautions stipulated in a work permit are normally addressing those
foreseeable risks or hazards and they are by no means exhaustive. Safety can only be
achieved by those preparing for the work and those carrying out work in accordance with
the work procedure, methods, use of right tools, and use the right judgment for which they
have been trained and made responsible.
PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 1 of 24

Permit To Work
3.0 DEFINITIONS
3.1 Permit-to-work System is a formal written system used to control certain types of work
which are potentially hazardous. It is also a means of communication among site
personnel to ensure all necessary safety precautions are taken before commencing such
work. The types of work permits are:
1) General Work Permit
2) Special / Associated Work Permit
(a) Work at Height Permit

(b) Electrical Work Permit
(c) Confined Space Entry Permit
(d) Hot Work Permit
(e) Excavation Permit
(f) Temporary Energization Permit
(g) Housekeeping, Material Lowering – Lifting Permit
(h) Lockout & Tagout Permit
3.2 General Work Permit it is the first level permit issued for jobs of general nature not
involving any special activities like Confined Space entry, Work at height, Excavation, Electrical
works, uses of cranes and hoist, Hot work, Lockout & Tagout & Scaffolding.
3.3 Custodian
Custodian is generally the Project Head of the particular DC construction project. Custodian is generally
the person responsible for implementing this PTW effectively in their respective projects. He will
primarily be accountable to ensure that all hazardous energy sources are isolated and conditions to
provide safe work environment for persons executing the job.
3.4 Issuer
Issuer is an employee designated by custodian with relevant job experience & authorized by custodian
who will issue work permit for respective area. Issuer should be knowledgeable of the hazards and
safety requirements for the equipment and process. He should be trained in this Work Permit procedure
and shall be responsible to get physical isolation of all hazardous energy sources to provide safe work
environment to the work initiator. The criteria for selecting Issuer should include educational background
and total experience within the DC.
3.5 Initiator (Also called Work Permit Acceptor-Person in charge)

Initiator is a person from the job executing agency having relevant educational background and/or
experience in the trade. In house employee authorized by Custodian will act as an initiator unless job
executing agency has a person already authorized as an initiator.
3.6 Authorized isolator
Authorized isolator is a person identified and authorized by Custodian as per the requirements in the
LOTO standard. Authorized isolator shall be different for different discipline like Electrical &
Instrumentation, Mechanical and any other facility/process.
3.7 Co-permittee (also called Permit Holder)

Permit To Work
Co-permittee means the person or the supervisor of a work group who is/are carrying out the job at site.
3.8 Hazardous energy sources
Hazardous energy sources are defined as any source of electrical, mechanical, hydraulic, pneumatic,
chemical, thermal, radiation or any other energy that, if not controlled, could cause injury to personnel
or damage to property and/or environment.
4.0 PROCEDURE
4.1 General Work Permit
4.1.1 Initiator will raise the General work permit in triplicate, by entering details in clause “A” of the work
permit (with the help of Issuer) after taking consent from custodian. He shall mention work
description in detail, date, time, duration and mention the list of equipment. Initiator will not start
the job while permit is under approval but can do the preparatory job till permit gets approved
from custodian. The Initiator shall ensure that the persons engaged are thoroughly briefed
through TBT about the relevant job steps, associated hazards & control measures (JSA) as per
the risk assessment. He will also ensure that relevant PPEs are provided. He will sign the permit.
4.1.2 The custodian will check & ensure that all Hazardous energy sources which are to be isolated
have been identified by initiator. If any additional isolation is required, Custodian shall identify it
and mention in Permit. He shall nominate an issuer and direct him to get isolation physically
completed and give clearance to start the job. He will sign the permit.
4.1.3 Issuer shall note isolations be done including those have been identified by custodian and carry
out isolation along with respective authorized isolator. Authorized isolators shall mention
equipment details, Equipment no and type of isolation made, LOTO Tag no in respective column
in clause “C” and shall mention his name and sign.
4.1.4 The Issuer shall visit site and ensure isolation of all Hazardous energy sources are completed by
respective authorized isolators. He shall ensure Checks mentioned in clause “D”. He shall give
clearance to start the work and sign the permit.
4.1.5 Initiator shall note Clause “D”, ensure and explain to the work group about issuer’s check list and
control measures stated in the permit clauses A, B, C & D for safe execution of the job. Initiator
together with the Co-permittee shall jointly inspect the site to confirm that all preparation work is
completed, and the permit conditions have been maintained on work site. He shall sign in clause
“E” of the permit and obtain signature of co-permittee in clause “F” & hand over the 1st copy of
permit (white) to the workgroup for display at job site. The 2nd copy (yellow) will be displayed at
the designated location (office / site) by the Issuer. The 3rd copy (pink) will be retained in the
book for records.
4.1.6 Duly signed & approved work permit along with associated permits, JSA & TBT shall be kept at
site where work group is performing the job.

Permit To Work
4.1.7 Initiator is responsible to maintain the status quo for control measures stated in the JSA/ work
permit during execution of work safely.
4.1.8 Co-permittee is equally responsible to maintain the control measures stated in the JSA/ work
permit during execution of work safely.
IMPORTANT: ANY CHANGES IN THE WORK PERMIT MUST REFLECT ON ALL THE THREE COPIES
4.2 Special Work Permits

If any work involves:
(a) Work at Height

(b) Electrical Work
(c) Confined Space Entry
(d) Hot Work
(e) Excavation
(f) Lifting Work
(g) Scaffolding
(h) Lockout & Tagout (isolation of energies)
Additional respective special work permit needs to be taken along with the General work permit. For
special work permit, respective standard shall be referred.
4.3 Closure of General Work Permits
4.3.1 When the job is completed, the Initiator shall ensure that all men and material is removed
from the site and ensure that isolations made, can be restored. He shall obtain signature of
the co - permittee and sign in clause “G”. He shall hand over the Permit copy (First copy)
to Issuer to close the permit.
4.3.2 The Issuer shall direct authorized isolators to carry out restoration of isolation as per clause
“C” and sign in clause “H”.
4.3.3 Respective authorized isolators shall carry out restoration of respective isolations as per
clause “C” and shall mention respective equipment tag no. in both copies of the permit and
sign in clause “I”.
4.3.4 Issuer shall ensure restoration of all isolation mentioned in clause “C” are completed and
shall sign the permit in clause “J”. He shall declare equipment ready to start and shall inform
the custodian.
4.4 Distribution of Permit
4.4.1 First copy (white) of the work permit and any attached permit(s) shall be with initiator / co-
permittee and shall be at job site.

Permit To Work
4.4.2 The second copy (yellow) shall be with issuer and shall be displayed at issuer’s designated
area. (Office/site).
4.4.3 The third copy (pink) will remain in the permit book and shall be available with custodian for
office record.
4.4.4 On completion of the work, all the three copies shall be signed by the concerned persons (as
detailed in section above).
4.4.5 The completed copy of the permit shall be retained at respective projects for office record
purpose along with all associated permits/documents for 1 year.
4.5 Renewal of General Work Permit
Permit shall remain valid for one shift, including General Shift. New work permits shall be issued
whenever Initiator or Co-Permittee is changed for any reason (even before completion of the shift),
A permit is valid for a specific scope of works, on specific locations with same team within a
specified period of time – it is valid till the end of the shift in which it is issued. If the work extends
beyond the shift it is issued, permit must be revalidated or renewed.
Procedure for renewal of Work permit, is as follows:
4.5.1 Issuer shall inform the custodian regarding the job being continued and the need for Permit
renewal. He will make a site visit if the work permit is to be renewed.
4.5.2 Initiator shall brief the work group regarding the hazards and the risk control plan/
safeguards and obtain signature of Co-permittee.
4.5.3 Issuer, Initiator and Co-Permittee shall sign all the three copies of permit and shall hand-
over the 1st copy to initiator.
4.5.4 Initiator shall restart work after renewal by issuer.
4.5.5 In the event of change in work group members, the Initiator shall inform the Issuer about
the change. He shall also explain the hazards and safety measures to new person(s) in the
work group. Undertaking of new members shall be obtained on TBT.
5.0 Deviation Process & Deviation Approval
Deviations from this procedure must be reviewed as per Annexure -IV by the Project Head of a
particular DC project in consultation with OHS Manager. Deviations must be documented (as per
Annexure-4) and documentation must include the relevant facts supporting the deviation decision.
Deviation authorization must be renewed periodically as necessary as and not later than one
year.
6.0 Emergency Deviations

Permit To Work
Emergency deviations must be authorized by the Custodian when, as a result of an unforeseen

event or situation, there is inadequate time to process a Normal Deviation. Emergency deviations
shall be authorized only where it is not feasible to comply with a requirement in this standard.
Emergency deviations shall be short in duration, not to exceed the time to perform the task in
hand. As a follow-up, the deviation must be documented in prescribed format (Annexure-4) and
a copy of the deviation must be sent to PDG OHS India Head with written information. The
documentation must include the relevant facts supporting the deviation decision and the interim
measures to be put in place to achieve acceptable levels of control measures.
7.0 RESPONSIBILITY AND ACCOUNTABILITY

Permit to work system shall be implemented with the custodian concept. Custodian is generally a person
responsible for managing the DC project.
7.1 Project Head for the DC Construction work are responsible to ensure that
• All their staff and contractors understand the permit-to-work system.

• Adequate training and instructions are given to their staff and contractors.
• Opportunities for improvement are identified through regular self-checks and actions are
taken to close the same.
7.2 Permit Initiator shall be responsible to obtain permit for the job he or she is executing.
Multiple permits for multiple work groups working on the same equipment will be required,
A permit is valid for a specific scope of works, on specific locations with same team within a specified
period of time – it is valid till the end of the shift in which it is issued. If the wok extends beyond the shift,
it is issued permit must be revalidated or renewed.
7.3 All individuals of the work groups working within the site have the responsibility to -
a. Have a good understanding of the permit-to-work systems and follow the PDG Safety
Standards SOP / HIRA / JSA briefed to them before commencing the job.
b. Ensure that they do not start work on any job requiring a work permit. Always wait till a work
permit has been authorized and issued, including a briefing at the work location.
c. Follow all the precautions and safety measures stipulated in the work permits and strictly
comply with the requirements and procedures of the permit-to-work system;
d. Stop work and get advice immediately from initiator when in doubt or in case there is any
change in circumstances or change of conditions which makes the work area unsafe.
e. Should not adopt any short cut while performing the job.
The above requirements to be ensured by custodian.

Permit To Work
8 Annexures
Annexure 1 - Flowchart to obtain general work permit

Annexure 2 - Flowchart to close general work permit
Annexure 3 - Job Safety Analysis Form
Annexure 4 - Deviation Request Form
Annexure 5 – General Work Permit Form
Annexure 6 – Special Work Permit Form
a) Work at Height Permit
b) Electrical Work Permit
c) Confined Space Entry Permit
d) Hot Work Permit
e) Excavation Work Permit
f) Lifting Permit
g) Scaffolding Permit
h) LOTO Permit
i) Night Work Permit

Permit To Work
Annexure I
Flow Chart to obtain General Work Permit
Fills in PTW Clause “A”,
Start Initiator Job Details, Time and

duration, Eqpt. Isolation
required.
Goes through list of isolation
Identifies additional isolation
Custodian / safety measures, directs

issuer to ensure required
isolations & prepare JSA with
initiator & issue permit to
work.
Carry out required

Auth. isolations as per clause “C”
Issuer through authorized
Isolator isolators. Gives clearance to
start the work
Briefs the job JSA/SOP,

safety measures taken to
work group.
Carry out actual
isolations as
Initiator Ensures initiator’s check list.
per clause “C” and as Handovers permit to work
directed by issuer group
Co- Ensures initiators check list.
Stop permittee
Follows the instructions
given by initiator & carries
out job.

Permit To Work
Annexure II
Flow Chart to Close General Work Permit
Removes men and

material from job site.
Start Initiator Takes sign of co-
permittee. Declare safe
to restore isolation.
Asks Authorized
Isolators to
Issuer restore Isolation
as per clause “C”
Auth.
Isolator
Ensures all isolations are

Carry out restoration restored. Closes the
isolations as per clause
permit & retain all three
“C” and as directed by
issuer
Issuer copies of permit. Informs
custodian Returns back
st
1 copy to Initiator
Initiator retains
Stop Initiator permit copy for 7
days as record.

Permit To Work
Annexure – 3
Job Safety Analysis Form
Job description: Analysis by Names (s):
Permit to Work No.: Reviewed by Name: , Approved by Name:
General Safeguards checklist:
□ Area barricaded, cordoned off □ Manpower deployed is trained □All PPEs, Tools and Equipment inspected
(esp. electrical, height work)
□ Isolations done as per LOTO (If □ Special Work Permits being □ This JSA explained to the workers during
applicable). deployed (if applicable) TOOLBOX TALKs
PPE Checklist:
□ Safety Helmet □ Safety Helmet with Welders mask □ Safety Helmet with Face Shield
□ Safety Shoes □ Safety Shoes (Electrical work) □ Safety Glass - Cutting, grinding etc.
□ Safety Goggles (for Chemicals) □ Dust Mask, Cartridge Mask □ Supplied Breathing Air, SCBA
□ Ear Plugs, Earmuffs □ Gloves – Ordinary, Cut Resistant, □ Protective suit – Hot Work, Chemical,
Chemical, Hot Work, Electrical Electrical (etc.)
Fire Safety checklist:
□ Area free of Flammables and □ Fire Hose laid out and ready □ Fire Extinguisher (Type, Size and
Combustibles, Gas Tests done (Quantity), Fire Water available Quantity)
□ Fire Blankets □ Sand Buckets (Quantity) □ Sprinkler/ detectors in area working?
Safeguard / controls to be put
Sequence of Basic Job Steps Potential Hazards Responsibility
in place

Permit To Work
Annexure – 3
Job Safety Analysis Form
Safeguard / controls to be put

Sequence of Basic Job Steps Potential Hazards Responsibility
in place

Permit To Work
Annexure – 4
PDG-IND-OHSMSM-1304 Deviation Approval Request Sr. No.
(To be filled by custodian)
Facility / Area: Date: Time:
Initiator: Department: Permit No.
Description of Works:
Description of Deviation:
Reasons for Deviation:
Precautions Taken to Mitigate Risk of Deviation:
Custodian Name: Custodian Signature:
OHS Head India: OHS Head India Signature:
OHS Manager, PDG Name: OHS Manager Signature:

Permit To Work
Annexure - 5
PDG-IND-OHSMSM-1304 General Work Permit Sr. No.
(A) To be filled and ensured by initiator Site Emergency Contact No:
Location: Department / Section: Date: / /
Description of Work: Equipment No (if any):

Time: : AM/PM
Duration: hrs
Name of Initiator: Agency / Company Name: Initiator’s Contact No.: Initiator’s Signature:
(B) Issuer to be nominated by custodian

Name of custodian: Name of Issuer: Custodian’s Signature:
Date: / / Time: A.M/P.M
Ensure the equipment isolated as listed in section C & ensure checklist as Clause D & also
additional isolation is also required.
JSA S/No. ____________________ HOT WORK S/No. _______________ LOTO S/No. _________ EXCAVATION S/No. _________
TBT S/No. HEIGHT WORK S/No. ____________ ELECTRICAL S/No. ______ LIFTING S/No. _____________
HIRA S/No. ____________________ CONFINED SPACE S/No. ________ SCAFFOLDING S/No. ____ OTHERS S/No. _____________
(C) To be filled by Authorized Isolator who is carrying out isolations
S. No. Description of Isolation Equipment Tag No. Isolation Details LOTO Tag No. Name of Auth. Isolator Signature
1.
2.
3.
4.
5.
(D) Checks to be filled & ensured by issuer Y N NA
1. Work area is free from any obstruction / hazards?
2. Sufficient illumination is maintained?
3. Is the area cordon off/ barricaded with required warning signs?
4. Have the vessel/equipment/line been positively isolated from all the energy sources?
5. Equipment / Tools inspected and tagged?
6. IS PPE provided and being used?
7. Are the person conducting work, suitably trained & competent?
Comment by Issuer: I have ensured that all required control measures as per clause C & D are Issuer’s Name: Issuer’s Signature:
completed. Identified workplace hazards, associated risk & adequate control measures as
determined & mentioned in the preliminary job safety analysis have been implemented & verified
onsite, also the same has been briefed to the job execution team through toolbox talks. I declare
the site is now ready for work execution. Date: / / Time: A.M / P.M
(F) Co-permittee: I am briefed and understood. I shall maintain site as per the work-
(E) Initiator: I have understood & verified clause D. Work can be started now. permit & associated checklist.
Date: / / Time: A.M / P.M. Date: / / Time: A.M / P.M
Initiator’s Name: Initiator’s Signature: Co-Permittee’s Name: Co-permittee’s Signature:
Renewal / Handover-Takeover of General Work Permit

Date of Renewal / Name, Signature & Time (Handing over) Name, Signature & Time (Taking over) Signature of custodian & issuer
Handover Co-permittee Initiator Time (From) Time (To) Co-permittee Initiator Issuer Custodian
Closure of General Work Permit
(G) To be filled by initiator: The Job is completed, all the men & materials removed from the site. Safe to restore the isolations (if any) as stated in clause C.
Date: / / Time: AM/PM Co-permittee’s Sign: Initiator’s Sign:
(H) I have restored isolation for following equipment’s from list (if any) stated in clause (c)
Equipment No: Equipment No: Equipment No:
Name of Authorized Isolator: Name of Authorized Isolator: Name of Authorized Isolator:
Signature: Signature: Signature:
Date: Date: Date:
Time: A.M / P.M

Time: A.M / P.M Time: A.M / P.M
(I) All the isolation’s made as per clause C are now restored. Equipment’s are ready for operation & now permit is closed. Work Permit received after job completion for record
purpose, Informed to custodian for job completion.
Issuer’s name: Issuer’s Signature:

Date: / / Time: A.M / P.M
Copy Distribution: 1st Copy (White) to be displayed at worksite. 2nd Copy (Yellow) to be kept for display & records (control room). 3rd Copy (Pink) for records with site.

Permit To Work
Annexure 6 – (a)
PDG-IND-OHSMSM-1304 Work at Height Permit Sr. No.
A. Permit Application (To be filled and ensured by initiator with the help of issuer)
Description of Work: Time: : AM/PM

Equipment No.:
Duration: hrs
Name of Initiator: Agency / Company Name: Contact No.: Initiator’s Signature:
JSA S/No. HOT WORK S/No. LOTO S/No. EXCAVATION S/No.
TBT S/No. GENERAL PERMIT S/No. ELECTRICAL S/No. LIFTING S/No.
HIRA S/No. CONFINED SPACE S/No. SCAFFOLDING S/No. ____ OTHERS S/No.
B. Work at Height Checklist (To be filled and ensured by Issuer)

S.No. Checkpoints Yes No NA S.No Checkpoints Yes No NA
Is there any overhead electrical line passing
1. Detailed JSA/HIRA available and attached 9.
through work area?
Activity wise standard operating procedure, safety
2. 10. Availability of safe access / exit.
precaution and requirements briefed to each workman.
Is approved scaffolding provided? Green tag provided
3. 11. Is fall arrestor provided?
for “safe to use” is provided.
If work at height is in confined space. Ensure confined Ensure full body safety harness with double
4. 12.
space permit is taken. lanyard is provided?
One observer / attendant is designated and is
5. Is safety net stretch under workplace? If required. 13.
present on the worksite.
Is work planned on fragile roof? Yes/No if, yes please Area below the job is properly cordoned off and
6. 14.
ensure use of roof top ladder. display cautionary sign board?
Are the height workers undergone medical
Is provision for tie up of full body harness to rigid
7. 15. examination & are examined for epilepsy & vertigo
structure or proper lifeline?
?
Has access equipment for height work been inspected

8. 16. Others (if any)
by a competent person?
Comment by Initiator: I certify that the above have been checked and found satisfactory.
Initiator’s Name: Initiator’s Signature: Date: / / Time: A.M / P.M
C. Permit Approval (Issuer)
Comment by Issuer: I certify that the above have been checked and found satisfactory. The permit is hereby approved and work at height is allowed subject to compliance
of all safety precautions and requirements stipulated in this permit and associated permits and work procedures.
Issuer’s Name: Issuer’s Signature: Date: / / Time: A.M / P.M
D. Confirmation & Acceptance
We have inspected at the work site and confirm that the permit conditions have been complied.
Initiator’s Name: Co-Permittee’s Name:
Initiator’s Signature: Co-Permittee’s Signature:
E. Work Completed (Initiator)
Work completed and all personnel and material have been removed.
F. Permit Closure (Issuer)
Inspected site and confirmed that the permit conditions have been complied with and the work is now completed.
Issuer’s Name: Issuer’s Sign: Date: / / Time: A.M/P.M
Copy Distribution: 1st Copy (White) to be displayed at worksite. 2nd Copy (Yellow) to be kept for display & records (control room). 3rd Copy with user for records.

Permit To Work
Annexure 6 – (b)
PDG-IND-OHSMSM-1304 Electrical Work Permit Sr. No.

Equipment No.:
Duration: hrs
JSA S/No. ____ HOT WORK S/No. ____________________ TBT S/No.
TBT S/ No. _________________________ GENERAL PERMIT S/No. ___________________ LIFTING S/No.
HIRA S/No. ____ CONFINED SPACE S/No. ________ SCAFFOLDING S/No. ___________
B. Electrical Work Checklist (To be filled and ensured by Issuer)
1. 7. Before carrying out maintenance work, existing

Is electrician possessing B license?
electrical installation drawing is fully understood.
SB, SDB has been provided compliance with

2. Electricians allotted work – trained in rescue & artificial 8. IP 44 for indoors & IP 65-67 for outdoors is
resuscitation in the last 6 months. provided?
3. 9. Welding cable, power cable & Gas cutting

For work on charged systems, buddy is provided. hose pipes are routed separately?
Rings, watch, chain, bracelets etc have been Is welding machine & all the connections were
4. 10.
removed before start of work. routed through RCCB/RCBO with tripping
sensitivity of 30 mA
5. All portable electrical equipment’s are having proper 11. All cables been routed above the head level or
plug with earthing. cable manager has been installed at the ground?
6. All cables/cords of portable tools have been inspected 12.

Others (specify)
for any crack, cut, poor cable/cord joint etc.,
Comment by Issuer: I certify that the above have been checked and ensured in place and JSA has been carried out. JSA form attached with work permit.
C. Permit Approval (Custodian)
Custodian’s Name: Custodian Signature: Date: / / Time: A.M / P.M
We have inspected at the work site and confirm that the permit conditions have been complied & safe to carry out Electrical Work in the area.
E. Work Completed (Initiator)
Work completed and all personnel and material have been removed and site is clear.
F. Permit Closure (Issuer & Custodian)
Custodian Name: Custodian’s Sign: Date: / / Time: A.M/P.M

Permit To Work
Annexure 6 – (c)
CONFINED SPACE ENTRY PERMIT
A. PERMIT APPLICATION (INITIATOR)
Confined Space / tank/Vessel No: Location:

Brief Description of Work in space/Vessel:
Expected Period of Work: From Date) (hrs) To (Date) __________(hrs)
Associated Permit(s):  Cold Work Permit (S/No. )  Hot Work Permit (S/No. )
 Work at Height Permit (S/No. )  Electrical Work Permit (S/No. )
GENERAL SAFETY CHECKS

 Written Rescue plan is available and attached  Lighting provided -24 V DC (Battery Operated)
 The vessel has been provided with *natural/forced ventilation  Vessel entry control board has been provided to identify and
 Workers have been thoroughly briefed on the scope of work, and monitor movement of vessel entry
personnel all safety precautions & requirements for vessel entry
 Others
I certify that the above have been checked and found satisfactory.
Name: Signed:
Date: Time
B. PERMIT APPROVAL (APPROVER)
 The vessel *contained/did not contain hazardous material  The vessel has been depressurized, drained, purged
 Type of hazardous material: and cleared of hazardous material and positively
 Gas tests to be carried out at following interval: every _hr isolated/blinded from all process/utility/electrical
 Gas tests have been carried out in the vessel/confined space systems.
 Lock, Tag & Try completed (Key Control Box No. )
 All employees involved are trained for the Job  Appropriate controls put in Place as per JSA
 Ensure Sufficient Illumination  Ensure Equipment grounding in case of Static charge
SAFETY REQUIREMENTS
Respiratory Protection Other PPE
 Respiratory protective equipment  Chemical suit. Type:
 Air-Line Respirator  Chemical gloves and boots
 Self-contained Breathing Apparatus (SCBA)  Lifeline  Other
Gas Monitoring Equipment
 Personal O2 meter with alarm Other
I certify that the above have been checked and found satisfactory. The permit is hereby approved, and vessel
entry is allowed subject to compliance of all safety precautions and requirements stipulated in this permit and
associated permits and work procedures.
Name: Signed:
Date: Time:
C. CONFIRMATION & ACCEPTANCE
We have inspected the work site on (Date) at (Time) and confirm that the permit
conditions have been complied with and it is safe to enter the vessel/confined space. Initial gas test has been
carried out. Subsequent gas test must be carried out every 2 hours interval and results to be recorded.
INITIATOR (CSE SUPERVISOR) APPROVER ISSUER
Name: Name: Name:
Company:
Signed: Signed: Signed:

Permit To Work
D. PERMIT RENEWAL
 The vessel/confined space has been re-surveyed, and conditions have not changed as per Annex—1 & 2
 The renewal of permit is granted from at hrs, to at hrs
INITIATOR (CSE SUPERVISOR) APPROVER ISSUER
Name: Name: Name:

Company:
Signed: Signed: Signed:
E. WORK COMPLETED (INITIATOR – CSE SUPERVISOR)

 Work *completed/suspended on at hrs and  The vessel/confined space has been re-surveyed
all personnel have left the vessel/confined space. and conditions have not changed. O2 content %
 The extension of permit is granted from
at hrs, to at hrs
Name: Signed: Name: Signed:
Date: Time: Date: Time:
F. PERMIT CANCELLATION (APPROVER/ ISSUER)

IMPORTANT NOTES
 Permit canceled at hrs on and all personnel 1) The permit is automatically suspended in the
have left the vessel/confined space. event of plant-wide emergency or if there are
 No further vessel entry is allowed unless new permit is issued changes in work site conditions making it
Name: Signed: unsafe to continue work in the vessel/confined space
2) Any deviations from approved permit will lead to cancellation
Date: Time: of the permit.
G. PERMIT CLOSURE (ISSUER)

 Permit closed on date at hrs on and ensured that all the personnel’s have evacuated from the vessel/confined space.
Name: Signed:
Date: Time:
 Tick where applicable, delete if not applicable  Delete where necessary

Permit To Work
Annexure 6 – (d)
PDG-IND-OHSMSM-1304 Hot Work Permit Sr. No.

Equipment No.:
Duration: hrs
B. Hot Work Checklist (To be filled and ensured by Issuer)

Has combustible material/oil spillage in nearby vicinity Is welding machine power on/Off switch is working
1. 9.
been removed / properly covered? or not?
Are gas regulators, hoses, torches, flash back

While carrying out the Arc welding job the earthing shall
2. 10. arrestors, welding cables and holders are ISI
be provided directly, and it shall be at on the job.
marked & in healthy condition.
Can spark / metal slag fall on any fuel / gas

3. Keep fire hose /sand/water hose near the job. 11.
cylinder/ cables / any combustible materials?
Has proper covering been provided i.e., GI sheet/

Is welding machine connection provided through
4. fire blanket over the fuel/gas cylinder/cables / any 12.
RCCB/RCBO – 30 mA
combustible material.
While carrying out cutting job the “Flash Back Arrestor”
Is LEL level to be checked prior to starting work as
5. shall be provided at both the side of hoses (at cylinder 13.
per Hot Work Standard.
& torch side)
6. Welding cable joints must be with lugs and insulated. 14. Others (specify)
C. Permit Approval (Custodian)
We have inspected at the work site and confirm that the permit conditions have been complied & safe to carry out Hot Work in the area.
Work Completed (Initiator)
E. Work completed and all personnel and material have been removed and site is clear.
F. Permit Closure (Issuer & Custodian)

Permit To Work
Annexure 6 – (e)
PDG-IND-OHSMSM-1304 Excavation Permit Sr. No.

Equipment No.:
Duration: hrs
HIRA S/No. CONFINED SPACE S/No. SCAFFOLDING S/No. OTHERS S/No.

Written excavation plan, meeting standard, is available
1. 5. Adequate lightening is provided
and attached
Emergency rescue equipment is available as per
2. 6. Caution boards and barricades provided
standard
Workers have been thoroughly briefed on the scope of If the excavation is deeper than 04 feet or more, is
3. 7.
work, Confined space entry permit obtained
Safety precautions and requirements of excavations
4. 8. Others (Specify)
completed
B. Clearance for Excavation
Before commencing the excavation, clearance should be taken from underground pipes and cables.
Civil Department: Name: Sign:
Utility Department: Name: Sign:
BMS: Name: Sign: Time: A.M / P.M
C. Permit Approval (Issuer)
I certify the above has been checked and found satisfactory. The permit is hereby approved, and excavation is allowed subject to compliance of all safety precautions
and requirements stipulated in this permit, associated permit and work procedures.
Issuer’s Name: Signature: Date: / / Time: A.M / P.M
We have inspected the worksite and confirm that the permit conditions have been complied with and it is safe to excavate the space.
E. Permit Closure (Issuer)
Inspected site and confirmed that all the personnel’s and material have been removed and site is clear.

Permit To Work
Annexure 6 – (f)
PDG-IND-OHSMSM-1304 Lifting Permit Sr. No.

Equipment No.:
Duration: hrs
TBT S/No. GENERAL PERMIT S/No. ELECTRICAL S/No. HEIGHT WORK S/No.

1. Is suitable sling /'D' shackle selected and its healthiness Lifting plan, SWMS & HIRA attached with
8. this permit?
is being inspected?
2. Are U clamps saddle grips seated on live ends of wire Crane fitness is being checked. More than 10 years
ropes? And min. 9.
old crane is being engaged?
3. Min 3 U clamps in Dx6 distance formula has been All safety devices such as ASLI and limit switches
provided? 10.
with auto cut off is functioning?
4. Dedicated signal man has been provided with Is SWL fall under 75% as per the crane
signaling device such as whistle, walky-talky? 11. load chart?
5. Are all height workers were provided with full body safety Emergency response team & Medical
12. facilities available?
harness?
6. Access and egress marked and without obstruction? 13. Lifting sling / belt is protected against sharp edges?
7. Competent lifting crew has been deployed? Others (If any)

14.
B. Permit Approval (Issuer)
Comment by Issuer: I certify that the above have been checked and found satisfactory. The permit is hereby approved and the lifting work is allowed subject to compliance
C. Confirmation & Acceptance
D. Work Completed (Initiator)

Permit To Work
Annexure 6 – (g)
PDG-IND-OHSMSM-1304 Scaffolding Permit Sr. No.

Equipment No.:
Duration: hrs
HIRA S/No. CONFINED SPACE S/No. HEIGHT WORK S/No. ____ OTHERS S/No.

Is there any overhead electrical line passing
1. Detailed JSA/HIRA available and attached 9.
through work area?
Activity wise standard operating procedure, safety
2. 10. Availability of safe access / exit.
precaution and requirements briefed to each workman.
Is approved scaffolding provided? Green tag provided
3. 11. Do castors (wheels) used for scaffold tower is of
for “safe to use” is provided.
appropriate SWL with locking arrangements, locked
and in good condition (5” dia. Minimum for light duty
and 7” dia. for Heavy duty)
Height of the scaffold restricted to 3.5 times the base Ensure full body safety harness with double
4. 12.
width. lanyard is provided if working platform is at
1.8mtrs and above?
5. Are outriggers used for scaffold stability when point no. 2 13. Is the working area of the scaffold extending
is not complied. outside the scaffold base dimensions
Are mobile scaffolds used on a firm & level surface Area below the job is properly cordoned off and
6. 14.
and all bracings in place display cautionary sign board?
Working platform provided with handrails and Is the safety rule:

7. 15.
toe board in all sides not to ride on a scaffold while in motion, violated
Access ladder extends 1 m above the landing point

8. 16.
Others (if any)
B. Permit Approval (Issuer)
Comment by Issuer: I certify that the above have been checked and found satisfactory. The permit is hereby approved and work at height is allowed subject to compliance
C. Confirmation & Acceptance
D. Work Completed (Initiator)

Permit To Work
Annexure 6 – (h)
PDG-IND-OHSMSM-1304 LOTO Permit Sr. No.

Equipment No.:
Duration: hrs
B. Issuer to be nominated by custodian
Name of custodian:
Date: / / Time: A.M/P.M Name of Issuer: Custodian’s Signature:
JSA S/No. ____ HOT WORK S/No. ____________________ SCAFFOLDING PERMIT S/No.
TBT S/ No. _________________________ GENERAL PERMIT S/No. ___________________ LIFTING PERMIT S/No.
HIRA S/No. ____ CONFINED SPACE PERMIT S/No. ________ HEIGHT WORK S/No. ___________
C. To be filled by Authorized Isolator who is carrying out isolations
S. No. Description of Isolation Equipment Tag No. Isolation Details LOTO Tag No. Name of Auth. Isolator Signature
D. LOTO Checklist (To be filled and ensured by Issuer)

Have you informed all affected employees that servicing, or
1. 7. Whether Stored or residual energy dissipated or
maintenance is required on a machine/ equipment and that
restrained?
the machine/ equipment must be shut down?
8.
2. Is equipment/machine is required to be locked out and tag out to Have you checked that no personnel are exposed
perform the servicing or maintenance? to hazardous energy/sources?
3. Whether authorized employee has identified the type and 9.

magnitude of the energy that the machine or equipment utilizes, Whether energy isolating device(s) lock out and tag
understand the hazards of the energy, and know the methods to out with assigned individual lock and tag?
control the energy?
Whether machine/equipment is operating and shutting it
10.
4. down by the normal stopping procedure is in workable Whether PPE provided to the concerned as identified
condition? (Such as depress stop button, open switch, in PPE Matrix / Risk Assessment?
close valve, etc.).
Whether the energy isolating device(s) is deactivated to 11. Have you verified the isolation of the equipment by
5. operating the push button or other normal operating
isolate from the primary energy source(s)?
control?
6. Have equipment / pipelines depressurized and Vent Opened, 12.

Whether machine or equipment is locked out and tag out?
process material emptied out and drained fully?
E. Permit Approval (Custodian)
F. Confirmation & Acceptance
We have inspected at the work site and confirm that the permit conditions have been complied & safe to carry out Electrical Work in the area.
4. Work Completed (Initiator) The Job is completed, all the men & materials removed from the site. Safe to restore the isolations (if any) as stated in clause C.
Date: / / Time: A.M/P.M Co-permittee’s Sign: Initiator’s Sign:
(H) I have restored isolation for following equipment’s from list (if any) stated in clause (c)
Equipment No: Equipment No: Equipment No:
Name of Authorized Isolator: Name of Authorized Isolator: Name of Authorized Isolator:
Signature: Date: Signature: Date: Signature: Date:
Time: A.M / P.M Time: A.M / P.M Time: A.M / P.M

(I) All the isolation’s made as per clause C are now restored. Equipment’s are ready for operation & now permit is closed. Work Permit received after job completion for record
purpose, Informed to custodian for job completion.

Permit To Work
J. Permit Closure (Issuer & Custodian)

st nd rd
Copy Distribution: 1 Copy (White) to be displayed at worksite. 2 Copy (Yellow) to be kept for display & records (control room). 3 Copy with user for records.

Permit To Work
Annexure 6 – (i)
PDG-IND-OHSMSM-1304 Night Work Permit Sr. No.

Equipment No.:
Duration: hrs
B. Issuer to be nominated by custodian
Name of custodian:
Date: / / Time: A.M/P.M Name of Issuer: Custodian’s Signature:
JSA S/No. ____ HOT WORK S/No. ____________________ SCAFFOLDING PERMIT S/No.
TBT S/ No. _________________________ GENERAL PERMIT S/No. ___________________ ELECTRICAL S/No.
HIRA S/No. ____ CONFINED SPACE S/No. ________ HEIGHT WORK S/No. ___________
C. To be filled by initiator who is carrying out night work and verified by issuer
S. No. Name of the worker Gate Pass / ID Workman Signature Name of the worker Gate Pass / ID Workman Signature
Number Number
D. Night Work Checklist (To be filled and ensured by Issuer)
S. No Checklist Y N N/A
1 Adequate illumination as per lighting standard SOP ref. PDG-IND-OHSMSM-2111 has been provided?
Emergency Vehicle (Ambulance) equipped with oxygen is available?

2
Vehicle driver Name: Contact Number:
3 Is construction medical officer as per BOCW is available in the shift?
4 Others (if any) -
E. Permit Approval (Custodian)
F. Work Completed (Initiator) The Job is completed, all the men & materials removed from the site.
Date: / / Time: A.M/P.M Co-permittee’s Sign: Initiator’s Sign:
G. Permit Closure (Issuer & Custodian)

st nd rd
Copy Distribution: 1 Copy (White) to be displayed at worksite. 2 Copy (Yellow) to be kept for display & records (control room). 3 Copy with user for records.

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PRINCETON DIGITAL GROUP

2.0 SCOPE & FIELD OF APPLICATION

• A permit-to-work is an essential part of Safety Management which provides a carefully

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 1 of 24

1) General Work Permit

2) Special / Associated Work Permit

(a) Work at Height Permit

3.5 Initiator (Also called Work Permit Acceptor-Person in charge)

3.6 Authorized isolator

3.7 Co-permittee (also called Permit Holder)

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 2 of 24

3.8 Hazardous energy sources

4.1 General Work Permit

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 3 of 24

4.2 Special Work Permits

(a) Work at Height

4.3 Closure of General Work Permits

4.4 Distribution of Permit

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 4 of 24

4.5 Renewal of General Work Permit

Procedure for renewal of Work permit, is as follows:

4.5.4 Initiator shall restart work after renewal by issuer.

5.0 Deviation Process & Deviation Approval

6.0 Emergency Deviations

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 5 of 24

Emergency deviations must be authorized by the Custodian when, as a result of an unforeseen

7.0 RESPONSIBILITY AND ACCOUNTABILITY

• All their staff and contractors understand the permit-to-work system.

The above requirements to be ensured by custodian.

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 6 of 24

Annexure 1 - Flowchart to obtain general work permit

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 7 of 24

Fills in PTW Clause “A”,

Start Initiator Job Details, Time and

Goes through list of isolation

Identifies additional isolation

Custodian / safety measures, directs

Carry out required

Briefs the job JSA/SOP,

Co- Ensures initiators check list.

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 8 of 24

Removes men and

Ensures all isolations are

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 9 of 24

Job description: Analysis by Names (s):

Permit to Work No.: Reviewed by Name: , Approved by Name:

General Safeguards checklist:

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 10 of 24

Job Safety Analysis Form

Safeguard / controls to be put

PDG-IND-OHSMSM-1304 Rev 00 / Sept 2022 Page 11 of 24

PDG-IND-OHSMSM-1304 Deviation Approval Request Sr. No.

(To be filled by custodian)

Facility / Area: Date: Time:

Initiator: Department: Permit No.

Reasons for Deviation:

Precautions Taken to Mitigate Risk of Deviation:

JSA S/No. HOT WORK S/No. ________________ TBT S/No.

TBT S/ No. _______ GENERAL PERMIT S/No. _ LIFTING S/No.