BLASTING PERMIT

1. Name of contractor :
2. Name of Blaster :
3. License No. :
4. Place where Blasting is to be carried out
(a) Location –1 :

(b) Location –2 :

(c) Location-3 :

5. No. of holes :

6. Time & Date when to be carried out :

7. Type of detonators to be used :
8. Type of blasting to be carried out –Open/Muffled :
9. Whether any Civil structure / public utility public
Utility: system/O.H. Electric lines are present
in the vicinity of blasting . if so, give details and
obtained clearance from the concerned agency :

10. JOB Hazard Analysis of the job carried out & check filled :

11. Blasting notification letter No. & Date :

Certified that all the precautions as mentioned in the Blasting Procedure, Blasting permit
and associated Check List will be complied prior to carry out the Blasting Operation.

Signature Signature

(Name of Engineer) Name & Designation of NPCIL

Contractor Permit Holder

Format No: HCC F 85 17 04 Rev. No 01, Date of Rev.:12.08.2010. Page 01 of 02