De-SHUTTERING Work Permit

Project Name: Permit No. DESWP/___________________________

Contractor Name: Date :
____________ /_________ / 202
Supervisor Name: Duration of Permission

Tower No. / Name: Permit Valid from: : am/pm

Location of
Deshuttering.
Floor No / Grid No: Permit Valid to: : am/pm

SL Check Points for De-Shuttering Yes No Comments & Action

1 Whether the area been fenced/cordoned off?

2 Warning sign "De-Shuttering in Progress" has been displayed?

3 Adequate illumination provided and available?

4 Clear access available and demarked?

5 SWMS approved for the de-shuttering activity and available?

6 Risk analysed and mitigation defined for the deshuttering activity?

7 TBT conducted to the worker before deshuttering work?

8 Competent supervision available for deshuttering work?

9 Safe working platform available?

10 Evacuate and barricade the area below the deshuttering area.

11 Safety catch net erected below the deshuttering area.

12 Trained worker engaged for the work.

13 PPE's including full body harness available.

14 Vertical protruding rebar removed from working area.

15 Independent anchorage provision provided for harness hooking.

CONTRACTOR AUTHORISED PERSON (i.e.Site Eng. / Supervisor) - (PERMIT GENERATOR ) :

Requesting and confirming by contractor’s representative: I confirm that the precautions specified above is complied with and the persons carrying out the De-
shuttering work are fully briefed on the safe method of work.

Name Signature Date

CONTRACTOR COMPETENT PERSON WITH COLLIERS REPRESENTATIVE (i.e.Site Eng. / Manager) - (PERMIT ISSUER) :
Confirmation: I understand and certify that the precautions & safe conditions mentioned above have been verified along with approved SWMS & de-shuttering
work is permitted.

Name Signature Date

Name Signature Date

IF DECLINED, ACTION REQUIRED BY CONTRACTOR WITH AGREED TIME LINE:

Note: -
1.The completed permit is to be hanging adjacent to the work being carried out along with copy of SWMS of the activity.
2. The work cannot be allowed, if the permit is not signed from Authorised person.
3. The Permit is valid for one shift / for 8hrs, If the work extends beyond the shift, new permit to be generated.
4. This permit is only to be approved for one location.
4. This work permit must be completed by the work supervisor and then be reviewed & signed by a Colliers representative.

V01: 22-08-2022 Page 1 Work Permits.xlsx