Night Work Permit

Project Name: Permit No.

NTWP / _________________

Contractor Name: Date :

________ /________ / ________

Trade Package Duration of Permission

First Aider Available (Yes/No) Permit Valid from(am/pm):

First Aider Name Contact No: Permit Valid to(am/pm):

Emergency Vehicle Available

Vehicle No: SWMS Available (Yes/No)
(Yes/No)

Name of the Driver Contact No: Workers Trained(Yes/No)

Activities scheduled for night & description of work to be executed:

Sl no Name of the Worker ID Number Sl no Name of the Worker ID Number

1 13

2 14

3 15

4 16

5 17

6 18

7 19

8 20

9 21

10 22

11 23

12 24

Reason for conducting these activities at night: -

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

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

Name Signature Date

To be filled by the Issuing Authority: (Specific Precautionary Measures proposed while carrying out the activity if Any)

CONTRACTOR COMPETENT PERSON WITH COLLIERS REPRESENTATIVE (i.e.Site Eng. / Manager) - (PERMIT ISSUER)
Confirmation: I understand and certify that the precautions & safe work conditions adopted and verified along with approved SWMS.
Name Signature Date

Note: Working at Height, HOT work etc, to be follow separate work permit.
Permit is Valid for One Night / 8 hrs. Permit to be displayed. No Female workers are allowed to work at night.