HEIGHT WORK PERMIT

Project Name Contractor Name/ Contact No

Location Date: Time: From To

Tools and Equipment involved:

Description of work:
The above signing person will be responsible to ensure that the above described work will be done under all the
safety precaution mentioned on the PTW and required by the Project.
The following precautions are to be taken
Sr No SAFETY PRECAUTIONS (Please Tick) Yes No / NA Remark
1 All people erecting in scaffolding shall be trained and
physically fit.
2 Safety Harness/belt checked and good working condition
3 Safety shoes (nonslip). Helmet with chin strip available with
employees.
4 All lifting / tightening tools, hand tools / equipment
checked and in good condition.
5 Access and exist marked and without obstruction.(Ladder)
6 Ensure Scaffolding (Supported, Platform, and Railing) with valid
tag available.
7 Ensure proper scaffolding and ladders
8 Unwanted and rubbish material removed from working
platform.
9 Electrical cable/ welding, cutting hose/ compressed air
hose properly secured and lay down without
obstruction.
10 Signboards provided on work place.
11 Employees aware about hazards and safe working
practices while working at height.
12 Checked safe condition of hand tools /power tools.
13 Life line is provided for height work.

Site Engineer Safety Officer Project Manager Site Engineer Safety Officer Project
(Contractor) / Supervisor (Contractor) /Supervisor /Supervisor Manager
(Contractor) (Kumar (Kumar (Kumar
Properties) Properties) Properties)

Permit Extension – Date Time –From To Sign

Site Engineer Safety Officer Project Manager Site Engineer Safety Officer Project
(Contractor) / Supervisor (Contractor) /Supervisor /Supervisor Manager
(Contractor) (Kumar (Kumar (Kumar
Properties) Properties) Properties)