SPC-03

VASAVADATTA CEMENT-SEDAM
CONFINED AREA WORK PERMIT
Permit SR. No. CSE /
Section: 1 To be filled in by Contractor First Line Engineer
Permit Valid from …………….. To …………., if Contractor First Line Engineer/supervisor or workmen changed then their signature should be incorporated in the
format
Cont. First Line Engr/ Sup. Name: Sig.: Date: Time: Department:

Description of work

Location

Action Taken by Executor : Please write Yes or No in the box provided.

Sr.No.
Safety Checks for compliance Yes/No NA Remark
1 Equipment isolated from main production line.
2 Intake and discharge lines valves etc., closed, blanked and tagged.
3 Work area is free from toxic gases/hazardous substance.
4 Checked work area temperature, is it bearable temp.?
5 Checked availability of ventilation and manhole is kept open.
6 Checked sufficient lighting and use of 24 V lamp inside confined place.
7 Have you taken PTW for electrical isolation?
8 Stairs ladders, platform provided to approach work.
9 Person engaged are experienced for the job.
10 Has all the safety precautions & hazards been explained to the workmen?
11 All required PPE's and Life Line provided to the workmen.
Checked availability of rescue arrangements and one person is positioned outside the confined area for rescue operation.
12
13 Other specified precautions

Please mention (Ö ) or mention "NR" (Not Required)

Safety Appliances
Signature of
Sr.No. Name of Workmen Apron &
Safety Hand Workmen
Ear plug Goggle Safety shoes Leg Others
harness gloves
guard

Please attach separate sheet for more No. of Workmen

PTW Issuer Name Signature Date Time

Area incharge
Concerned HOD/DGM

Section-2 : Acceptance To be completed by the person who will carry out the job. Then to be handed back to issuing person.

I have personally checked the specific job site and found it to be strictly in agreement with the requirements of the method statement and risk
assessment recmmendation. No work will be carried out other than the work authorised by this permit
Signature: Date: Time:
This job will be supervised by (Name). …………………………………………………………………. (Contractor First Line Engr/Sup.)

Cross Checking Above measures are cross checked and work can be continued Checked By Date Signature
Safety Engr(VC)
Additional measures required, if any:

Day Extension / Transfer of permit All checks reviewd & found OK to extend permit
Date Signature Date Signature Date Signature Date Signature Date Signature
Cont. First Line Engr.
Area incharge (Cont.)
First Line Engr. (VC)
Safety Personnel (Cont.)
Safety Personnel (VC)
Night Extension / Transfer of permit All checks reviewd & found OK to extend permit
Date Signature Date Signature Date Signature Date Signature Date Signature
Cont. First Line Engr.

Area incharge (Cont.)

Area incharge (VC)
Safety Personnel (Cont.)
Safety Personnel (VC)

To be completed by the Job supervisor who supervise the work inside confined area, after the work is finished. Then to be handed back to
Section-3 : Completion issuing person.

Signature: Date: Time:

The above work is completed. Man power deployed is removed from the working site. (Contractor First Line Engr/Sup)
Section-4: Cancellation : I declare that this permit is now cancelled. No further WORK inside confined place is allowed untill a new permit is issued.
Name Department Signature Date Time

1. This permit Applies only to work in the location described. Any further work inside confined place must have another permit issued for prescribed validity
Note :
2. This permit only applies to the person to whom it is issued. If work has to be continued by someone else, this permit must be returned to issuer for canellation and
another permit issued.

Copy : (1) To be displayed at Work Spot (2) Safety Officer, * Validity Period (6+1) days Page 1 of 2
 SPC-03
Scope of Application and guidelines for Use

Purpose : This procedure describe the methodology for taking and releasing of written Permit to work in confined area.

Scope : This is applicable to work in confined place like Silo, ESP, Cyclone, Bin Hopper, tank etc.

Procedure : 1. All HOD's are responsible for the implmentation of this procedure in their area.
2. Contractor First Line Engineer under whose direct supervision the job is being carried out is responsible for obtaining
the permit from concerned Engineer.
3. Concerned Engineer & HOD are authorized to issue the permit.
4. Contractor First Line Engineer will hand over the second copy of the permit to Safety Deptt. before starting the job
5. The Safety Officer/Concerned HOD shall cross check the permit at site
6. Concerned area in charge of contrator is responsible for obtaining the Electrical work Permit/Process clearance, if required.
7. Permit issuing authority must take all the necessary precautions and verify all the points at work site as mentioned in permit.
8. Both Issuer and Acceptor must sign the permit to indicate acceptance of Permit
9. Original copy of work permit to be displayed at working site.
10. Permit will be reviewed & signed on daily basis by Contractor First Line Engineer and Issuing authority
11. Permit will become invalid if Job supervisor or workmen and/or both changed for the same activity,
then fresh permit should be taken before starting of the job.
12. Permit must be handed over by Contractor First Line Engineer to concerned Engineer after completion of work inside confined place.
13. Concerned Permit issuer will cancel the permit after reviewing the work site.
14. Contractor First Line Engineer will submit the permit in Safety deptt. after cancellation.
15. Retention period of cancelled permit is 7 days.
16.Daily attachment sheet shall be attached with the permit for day and night shift separately
Authority: HODs/Safety Officer can stop the work incase of adequate safety measures are not taken for safe job execution

REMARKS:

Safety Appliances WAH Trained

Sr.No. Name of Workmen Fullbody Safety Hand Signature
Ear plug Dust Mask Yes No
harness Shoe gloves