Permit Number:………………

WORK AT HEIGHT PERMIT

(TCPL Green Energy Solutions Private Limited)

Work by: □ Employee □ Supplier (Write name):

Date: Start time: Completion time:
Extension required up to time:
Area of Work & Exact work location:
Permit Owner __________ BUL____________
Permit Owner:
Description of work:

Permit Owner Name: Signature:

* I explained all the safety requirements w.r.t. Height work permit and work-related hazard to Permit Acceptor &
Standby Person.
Standby Person: (This shall be additional to the work site supervisor in case of Lone person working at height)
I inspected area at fall protection equipment w.r.t. work at height hazard and found area safe and fall hazard free.
The work shall be monitored & controlled by me from start to completion of the Job

Standby Person: Signature:

BUL:
I reviewed, the area is safe, and work can be permitted for above task. I ensure that the all affected employees shall be
communicated of the hazard.

BUL Name: Signature:

Permit Acceptor:
I ensure that the area shall be continuously under supervision from start to completion of the job and all required
displays/ warnings/ indications shall be maintained throughout the job execution period. I understand the Excavation
work to be performed and the necessary safety precautions to complete the work safely as outlined in this permit,
method statement and/or risk assessments. If conditions change to the extent that this permit, the method statement
and risk assessments become invalid, it is my responsibility to stop work immediately and notify the Initiator.

Permit Acceptor Name: Signature:

Permit Approver:
I inspected the area is safe w.r.t. to Height work permit requirement and work can be permitted for above task.
Additional Comments: -

Permit Approver Name: Signature:

Sl. No. Name of the Person Carrying out the Work Safety Harness Sl. No. Signature

Closing of Permit / Final check

Permit Acceptor:
I declare that the work described above is complete, all work equipment, persons and materials under my control have
been withdrawn. All safeguards have been reinstated, Housekeeping is adequately done and the work area returned to
a safe status and service. I also declare that the permit is ready to close.

Permit Acceptor Name: Signature:

Standby Person:
I inspected and verified that all personnel and materials have taken down from height.

Standby Person Name: Signature:

Permit Owner:
I formally close the Permit hence all the work done and now area is fully safe from above completed task

Permit Owner Name: Signature:

Format No: HSEMS-OCP-01-F-02 Revision No: 01 Revision Date: 25/07/2020

 Permit Shall not be issued until following precautions have been checked & completed
Sr. Yes N/A Requirement Sr. Yes N/A Requirement
1. The following hazards are associated with work: 4. Ladders:
Ladder inspected and found in
Falling Objects
1.1 4.1 good condition?
1.2 Risk of Falling Persons 4.2 Secured and long enough?
1.3 High Winds 4.3 Base is mounted on good footing?
1.4 Overhead Electric Cables 4.4 If extended then 2 rung overlap?
Barrier at base of ladder and
Unguarded Edges
1.5 4.5 warning sign in place?
1.6 Unsecured Ladders
1.7 Lack of Space 5. Access Scaffolding:
Barrier and warning signs in
Uneven Floor Surfaces
1.8 5.1 place?
1.9 Manual Handling of Loads 5.2 Toe boards in place?
1.10 Fragile Roofs 5.3 Hand rails in place?
Other hazards, not listed
Scaffolding Inspected by:
above:_____________________
5.4
_________________________
1.11 ___________________________

2. The work involves the following - 6. PPE:

2.1 Ladders 6.1 All required PPE provided?
All PPE inspected and observed in
Scaffolding
2.2 6.2 good conditions.
2.3 Excavation/ Pits (falling below)
2.4 Boom Lifter/Scissor Lift
Emergency Contact No.- 0657-6131-204/207
3. Working at Height:
3.1 Approx. height for work: _______
3.2 LOTO required?
3.3 Lone Working?

Important Notes:
1. USE OF LADDERS
Ladders should be in good condition. They should be long enough for the work in hand.
Ladders should be secured both at the top and bottom
If extensions are used there should be at least two rungs overlap. Taper ladder can be used with Secondary support only.
Sufficient clearance must be provided at the base of the ladder with barriers and warning signs
Observe the 4:1 rule. Ladder Inspection checklist to be filled prior to use.

2. USE OF STEP LADDERS

Hinges, fittings and cords should be in good condition
Treads should be secure and not cracked or broken
Steps should be set correctly, level and secure, open to full extent and adjusted to the correct angle
Ensure that work can be completed safely without over-reaching or standing or kneeling on the top step or platform
Sufficient clearance must be provided around the ladder with barriers and warning signs provided
Ensure that excessive the work does not require excessive weight to carried i.e. sheets of wood or plaster board

3. USE OF SCAFFOLDING
Scaffolding must be erected by a Trained Scaffolder. Checking to be done as per Checklist.
It must be protected against damage from traffic
It must be barriered off and any one inside the barrier must wear head protection
Toe boards must be in-place to stop items from being knocked off the scaffolding
Hand rails must be fitted at all points where there is a risk of falling through
Scaffold tags shall be in place

4. WORKING AT HEIGHT
Fall prevention measures should be used i.e. barriers
A safety harness with shock absorber should be worn wherever reasonably practical, where other controls are not
employed

Format No: HSEMS-OCP-01-F-02 Revision No: 01 Revision Date: 25/07/2020