Dhaka Mass Rapid Transit

Development Project, CP - 07 Marubeni

Doc. no.: DMRTDP/MRT-6/L&T/EHS/05
Permit No.:-o43/nay-23 Rev. No.: 01

Requested by (Permít Receiver

GENERAL PERMIT TO WORK (PTW)
|Holder): Department Designation Company
Permit Validity ExPeRT
From Time .ofy. Date 22.]"sfel Time b:6opn.Date
Permit Extension From Time. Date.
224«sfes
Time Date.
Work area and description of work scope to be
performed: S10

Specific Permits Required YES NO Preventative Measures Taken YES NO

Hot Work Permit required.
Vyethod Statement prepared/ reviewed
Excavation/ Trenching Permit required. Pre Job Briefing to be conducted.
Track work permit
Jaspect Color Coding of tools/equipment as being
current, i.e. rigging, power tools, electrical cords, fall
Iprotection, etc.
|Lock-out &Tag-out lsolation/ HV Voltage Clearance Expansion joints and drain hole has been closed (Only
|Permit required. for Viaduct).
Lifting Permit required. Access tolfrom work location adequate
Work at Heights Permit required. Additional Emergency arrangements required.
Electrical Installation Permit required. Specific PPEs for the Activity YESNO
Welding and/or Grinding Shield required.
Rubber Boots required during concrete
Dust Mask/ other respiratory equipment required. List
other Permits/ Documentation Approvals required details:
J(Specific), i.e. Inspected Scaffolds with Tags, MSDS, 100% fall protection required above 2.0 meters. Full
Grating Removal/lnstallation, etc. List details: Body Harness/ Personal Fall Arrest System (PFAS)
Determine anchor point, load capacity 2268kg per
|person. (Lifeline 2 person max per attached span).
JList details:

Equipment involved for work scope, Ljst details: Gloves: Leather )/ PVC( )/Welding ()

Had torb, dn m |other PPE, List: Ct lev 0ce f

PTW Issuonce: Ime &Date
Permit Reviewed &Accepted by Permlt
Receiver/Holder
IPrint
22/"S2
Precautions Corfirmed by Safety Representatlve , aurav h
Person Print S/gn 22/°y2 ,
Permit Approved &lssued by Authorized

Tie & Oate

PTW Completion & Closure: |Sign
|Print
Permlt Receiver IHolder confirms all work
|completed and cleared PTW closure. Pont |Sign
TumE 3 Date

Permit Authorlzed Person confirms activity and

crew or
work area safe for turnover to other work
lentity and closure of PTW.
be kept for reference
location and other specific permit shall
Note: PTW must keep at the work
1of
Sensitivity: LNT Construction Internal Use
Dhaka Mass Rapid Transit
Doc. no.: DMRTDP/MRT-6/L&T/EHS/56
Development Project, CP- 07 Marubeni
Rev. No.: 01

PERMIT TO WORK AT HEIGHT

Permit No.: 73
nay-23
Requested by (Permit Receiver/Holder): Department: Designation: Company:
Permit Validity LØE To Time..: 9AP. Date..22/rkfas
From Time.. .Date..ase
Permit Extension From Time. Date. To Time. Date...

Work area and description of work scope to be

performed: o

Tick out( )thework-related hazards:

Noise Manual Material Handling
Vibration
Movement of vehicle at workplace
Hazardous substances Fire
Work at height Load handling equipment
Electricity
Ergonomics and workst at io n design Slip, trip and fall
Lone working
Action taken Remarks
SI.
Risk control measures (Yes/No/NA)
No
1 Whether Safe access to work place is provided?
2 Whether the edge protection provided adequate?
3
Is the work area away from the vicinity of moing objects?
Whether work platform is adequate with respect to strength and dimension?
5 Is the working platform fully boarded?
6 Work platforms provided with guard rail?
7 Are the workmen screened for working at height?
Lanyard
Adequate fall protection arrangement made (Static line, Double
harness, Fall Arrestor, Safety Net)? Action taken
Remarks
Risk Control measures for avoiding Fallof Materials (Yes/No/NA)
is restricted?
Work at more than one elevation at the same segment
loose material?
2 Walkways, aisles & alloverhead workplaces cleared of
3 Whether all tools & tackles inspected before use?
against accidental falI?
Whether hand tools & handling materials secured
Workmen provided with bag /box to carry bolt, nuts & hand tools?
5
being performed is cordoned
6 Whether area below, where the height work
and unauthorized entries are avoided?

TIck out () Personal Protective Equipment's (PPEs): Safety Shoe Full body harness with Double lanyard
Reflective Jacket
Safety Helmet
Earplug Eye protection (Goggles)
Cotton hand gloves Leather hand gloves
Nose mask Gum boot Face shield (welding/Grinding)
Body apron
Any other PPE used:
Print Sign
/Holder
Permit filled & Reviewed by Permit Receiver
Sign
22f%
Timc& Oato
Print
Precautions Conflrmed by Safety Representative
Tirne & Date
Print.
Permit Approved & Issued by AuthorizedPerson

me&Dat
Print S-g.
Permit Receiver/Holder confirms all work completedand
cleared PTW closure. ime& 0at
safe for Print
Permit Authorized Person confirms activity and work area
turnover to other work crew or entity and closure of PTW.