Health, Safety & Environment

Work Permit for Electrical work.

Project: SATTVA IMAGE TOWER PROJECT Permit Sr. No.

Section 1
Name of
Name of Performing Authority
Subcontractor
Department Work Location

Date………………………………………………………………Maximum valid for 12 hrs.

Time: From ……………… AM / PM To………...……AM / PM.

Description of Work
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………

Section 2

CHECK POINTS
Sr. No. Condition to be observed Yes No Remarks
1 All Electrical work performed by qualified electrician
only
2 LOTO applied (If required)
3 Line clearance done
4 Circuit checked for zero voltage
5 Portable cords & Electric tools inspected
6 Safety back-up man appointed.
7 The area cordoned off with caution tape & signages
placed
8 Rubber and leather gloves Available
9 Insulating mat Available
10 Disconnect pole or safety rope Available
11 Nonconductive hard hat Available
12 Flash protective clothing Available
13 Safe access/egress ensured
14 All combustible materials have been removed
15 Fire extinguisher placed within 2 mtr radius of
ignition source
16 Adequate ventilation and illumination
17 Tools and equipment inspected prior using it.
18 Job briefed to all crew
19 Required PPEs available with the crew
20 All electrical wiring cable/wiring dressed well and
safe

Page 1 of 2
 Section 3

The above-mentioned precautionary measures have been checked / verified and

found in order.
Requesting Performing Issuing Authority
EHS Person
Authority Authority
(KEC) (Client)
(KEC) (KEC)
Name

Signature

Date & Time

Section 4

Post job verification and closure

Work Completed / Stopped / Area Cleared

Requesting Performing Issuing Authority

Authority Authority EHS Person
(Client)
(KEC) (KEC) (KEC)

Name

Signature

Date & Time

(Please return permit to HSE Coordinator)

Page 2 of 2