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49MWac CORDON SOLAR POWER PROJECT

Employer

Greenergy for Global Inc.


Employer’s Engineer

AFRY Philippines Inc.


Contractor

Consortium of Everstone & SUMEC Philippines

Document name PERMIT TO WORK PROCEDURE


Document No SUMEC-HSE-PERMIT TO WORK PROCEDURE-004

Date Issued APRIL 25,2024

Rev 0

For Contractor
Prepared by: Checked By:
Name: RUTHCHELLE M. CAMPOS Name: WANG WEI
Position: Safety Officer Position: Project Manager
Signature: Signature:

Date: April 25, 2024 Date: April 25, 2024


For Employer & Employer’s Engineer
Reviewed or approved by:
Name:
Position:
Signature:

Date:

✔For Review □ Reviewed


For Approval □ Accepted □ Accepted w/ comments □ Revise & resubmit

1
PERMIT TO
WORK
PROCEDURE

DOCUMENT APPROVAL
NAME POSITION SIGNATURE
PREPARED BY: RUTHCHELLE M. CAMPOS HSE Officer
REVIEWED BY: FERDINAND L. SECULLES HSE Manager
APPROVED BY: ZHU TENG Site Manager

2
TABLE OF CONTENTS

page
What is Permit To Work System? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
How is work controlled within the Permit To Work System? . . . . . . . . . . . . . .3
Types of Permit To Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Permit Issuer Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Permit Receiver Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
HSE Permit Coordinator Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . 4
Operational Procedure for Work Permit System . . . . . . . . . . . . . . . . . . . . 4
Re-validation of the Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Emergency Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Work Permit Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Cold Work Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Excavation Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Electrical Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Confined Entry Space Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Hot Work Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Lifting Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Work at Height Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Equipment Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Appoinment Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

3
Permit To Work
What is Permit To Work System
• The PTW system is a formal written procedure used to control access and activities of
personnel in the construction.
• To ensure safety of personnel and to prevent damage to equipment.
• It also means of communication between site management, supervisors and operators,
who carry out the work.
• PTW normally implemented in a work activities near or inside the operating facilities,
there's buried or near operational system or where the clients thinks that PTW is deemed
necessary.

How is work controlled within the Permit To Work System


Work is controlled by following various steps detailed in the permit to work procedures and
by using special documents called WORK PERMIT.
Work permits are not simple permission to carryout work, but they determine how the work
can be carried out safely.

Types of Permit To Work


• Hot Work Permit
• Confined Space Entry Permit
• Electrical Permit
• Excavation Permit
• Lifting Permit
• Cold Work Permit
• Work at Height Permit

Permit Issuer Responsibilities (Project Manager/Site Manager, Site Engineer & HSE Manager)
• The Issuer has the sole authority to issue the permit.
• The Issuer shall be fully aware of site conditions, the type of work to be carried out and all
the requirements stated in the permit.
• The Issuer shall conduct an onsite inspection jointly together with the Receiver to ensure
that site conditions are safe to permit the work and all requirements stated in the permit are
implemented prior to the issuance of the permit.
• The Issuer shall withhold the issuance of the permit if the requirements are not met, or site
conditions are not safe for the work to carry out.
• The Issuer shall, if noticing the presence of any other potential hazards, risks that may
jeopardize the safety of the worker, tools or equipment advice the Receiver of appropriate
countermeasures to be taken.
• The Issuer shall ensure that all required safety monitoring measurements are properly
done and so stated in the permit.
• The Issuer shall ensure all personnel involved in the work are fully aware of Emergency
procedures.

4
• Once informed the work is completed, the Issuer shall visit the site jointly with the
Receiver to ensure that the work is ceased and the site is kept clean and tidy without any
smouldering exist.
NOTE:
“In absence of the HSE Manager, his Deputy may take charge and shoulder all
the responsibilities.”

Permit Receiver Responsibilities (Site Manager/Site Engineer/Foreman & Safety Officer on site)
• The Receiver shall be fully aware of all requirements stated in the permit and comply with
them at all times.
• The Receiver shall fully brief the work crew to ensure that requirements are clearly
understood by the crew under his supervision.
• The Receiver shall ensure the work is performed in accordance with the conditions
specified in the permit. He shall remain at the work site to supervise the work.
• The Receiver shall ensure that under no circumstances shall by his own discretion or his
crew change the original scope of the work, which is described in the permit.
• Whenever site conditions are drastically changed, the Receiver shall immediately stop the
work and inform the Issuer of the change for further instruction from him.
• Upon the occurrence of an emergency the Receiver shall immediately stop the work and
shut down all equipment.
• The Receiver shall report the completion of the work or the expiration of the validity of the
permit to the Issuer and ensure that the site is kept clean and tidy without any smouldering/ignition
sources.
• If the work in progress requires extending the validity stated in the permit, the Receiver
shall request an issuance of new permit.

HSE Permit Coordinator Responsibilities


• The HSE Permit Coordinator is responsible for daily coordination of the work permits.
• He is responsible for full clerical control of the system including retention of the closed out
Work Permits for one-week period.
• Has the full overview of the planned, open and suspended work permits on visual display
in his permit to work office.

Operational Procedures for the Work Permit System


1. A Work Permit consists of a set of three pages. One page shall be kept by the Receiver and kept at
the work location, one page shall be kept by the Issuer and one page shall be kept by the HSE
Permit Coordinator.
2. The description of the work shall be a precise statement of the planned activity, the location of
the work by identification of the area or equipment to be worked upon.
3. Method Statements, Risk Assessments and/or Job Hazard Analysis will be produced for
critical activities and shall be attached to and form part of the permit. Such additional
documentation shall be attached to the original of the Permit.
4. Where additional Permits or Certificates are required, they will be attached to and form part of
the Permit to Work.

5
5. The Receiver shall produce the permit to Contractor responsible personnel for the work
requested in the permit for review and verification prior to the commencement of the work.
6. As soon as the review and verification has been made, the Receiver shall bring the verified
permit to the HSE Permit Coordinator.
7. The HSE Permit Coordinator shall scrutinize the permit including safety precautions and
requirements stated in the permit and deliver it to the Receiver. The HSE Permit
Coordinator should consult HSE personnel for professional advice or suggestions required to
work safely.
8. The Receiver shall bring the permit to the Issuer who shall review the permit to ensure that all
required safety precautionary measures are stated and authorizes the permit.
9. On the day of the work, the Issuer in the person together with the Receiver shall go to the site to
ensure that all requirements in the permit are met and hand over the permit to the Receiver
10. Issuance of the permit to the Receiver in the office shall not take place.
11. Upon receipt of the permit from the Issuer, the Receiver can commence the work.
12. When no further work is to take place under a permit, the Receiver shall sign off and
return the permit to the Issuer to close the permit.
13. Upon receipt of the permit, the Issuer and the Receiver shall inspect the work site to
ensure that no smouldering is present, the work site is clean and tidy and equipment is left
in a safe condition.
“The issuer shall return the invalid permit to the HSE Permit Coordinator for file.”

Re-validation of the Permit


• When the work calls for any extension of the permit, the Receiver shall suspend the work
and request an extension of the validity to the Issuer.
• The Issuer is responsible for ensuring that all precautions and requirements are still in
place and the conditions in the work site are maintained safe for personnel and equipment.
• If the issuer agrees to extend the permit he shall define the time of the expiry and sign in
the permit to authorize the extension.
• The Receiver returns the extended permit to the work site and resumes the work.

Emergency Situation
• When an emergency, such as a fire incident, Toxic Gas Release, Natural calamities has
taken place the Receiver shall immediately stop all works and shut down all equipment.
• All permits shall be nullified and no work shall be resumed unless new permits have been
issued out by the Issuer.
• Prior to the issuance of a new permit, the Issuer shall visit the work site to ensure that
there is no imminent hazard/risk present and that the work site is safe for work.

Summary
• The Permit to Work is designed to provide a safe system of work that can be applied to
works identified by virtue of perceived risks.
• This shall be applied to the Contractor controlled Construction activities on the Project.
• Permit requirements for activities other than those mentioned in this procedure will be re-
evaluated especially for potentially hazardous activities where an extra degree of work control is felt
to be appropriate.

6
WORK PERMIT FLOW CHART

Responsible HSE Permit FILE PERMIT


ORIGINATE PERMIT
Supervisor Coordinator

Permit Receiver
(Site Manager, REVIEW/VERIFY Permit Issuer
CLOSE PERMIT
Site Engineer/ PERMIT & Receiver
Foreman &
Site Safety Officer)
YES

HSE Permit ACCEPT PERMIT RE-VALIDATE PERMIT


Coordinator NO

Permit Issuer
(Project Manager/
AUTHORIZE PERMIT CARRY OUT WORK WORK FINISHED?
Site Manager,
Site Engineer &
HSE Manager)

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COLD WORK
PERMIT

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9
Rev. No. 002

49MWAC CORDON SOLAR POWER PROJECT

COLD WORK PERMIT PTW Control Number: SUMEC-HSE-

Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Project / Site
Permit Issuer Name: Contact No.
Manager Sign
(SUMEC)
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Daily Checklist of Heavy Equipment Shelter for workers provided
Training induction of workers completed Toolbox Attendance/Meeting conducted
Machine Operated by Certified Operator Materials properly store and arranged
Personal Protective Equipment for workers provided Ladder use inspected
Area work clean and tidy Workers away from a moving heavy equipment
Material proper arrangement Adequate illumination during night work
Rest Shelter First aider certified and availability at site.
Enough Drinking Water for the worker Safety coverage on site.
Area barricaded Waste material segregated
Housekeeping being conducted Access clear of obstruction.
Declaration by the permit requester/receiver

I _______________________ representing ___________________________________, hereby declare that I have


checked the location and workers has been briefed about the emergency procedure and toolbox meeting given.
Date: Name and Sign:
Section IV - Approval

Reviewed by HSE Offi cer/Manager (SUMEC) Name: Sign: Date:

Work shall be carried out only after complying with the precautions given in the section III of permit

Approved by Project / Site Manager Name: Sign: Date:


Section V - Work Permit Closed

This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)

Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign


Date: Date: Date: Date: Date: Date: Date:

Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign


Date: Date: Date: Date: Date: Date: Date:
REMARKS:
10
Cold Work Permit
A Cold Work Permit is a written document issued by an organization or facility to authorize
personnel to conduct activities that do not generate heat or involve ignition sources but pose
potential hazards to personnel or equipment. It is a safety measure to ensure that workers know
the risks associated with the task and are adequately trained and equipped to complete the job
safely.

A cold work permit typically outlines the specific tasks to be performed, the associated hazards, and
the precautions that must be taken to mitigate the risks. The permit may also include information
on the duration of the work, the personnel involved, and the necessary equipment and tools
required to complete the job safely.

Examples of cold work activities that may require a permit include:


 Painting – Painting activities may require a cold work permit to ensure that workers are
protected from exposure to hazardous chemicals and that proper ventilation and personal
protective equipment (PPE) are used.
 Operating machinery – Operating machinery such as backhoes and compactors can be
hazardous if proper safety protocols are not followed. A cold work permit may be required to
ensure workers are trained and certified to operate the equipment safely.
 Erecting scaffolding – Scaffolding can be hazardous if not erected properly. A cold work permit
may be required to ensure that workers are trained to erect the scaffolding safely and that
proper safety equipment is used.
 Using cranes or heavy lifts - Using cranes or heavy lifts can be dangerous if not done properly. A
cold work permit may be necessary to ensure that workers are trained to use the equipment
safely and that proper safety protocols are followed.
 Handling heavy objects – Handling heavy objects can lead to injuries if not done safely. A cold
work permit may be required to ensure that workers are trained to handle heavy objects
properly and that proper lifting techniques are used.

11
EXCAVATION
PERMIT

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Rev. No. 002

49MWAC CORDON SOLAR POWER PROJECT

EXCAVATION PERMIT PTW Control Number: SUMEC-HSE-

Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Has services indicated by walk through with Water / Sewer / Irrigation / Drainage
operatives designated to the task and safe (1m exclusion)
exclusion zones been indicated by barriers
Has a Risk Assessment been completed for the Has area been checked under ground utilities
task of excavating
Have the Operatives for the task been briefed on Are all service locations clearly marked?
the Risk Assessment. Is this signed for?
Are required controls in place as per the Risk Necessary trial trenches been excavated
Assessment?
Electrical 11kV or higher voltage (3m exclusion) Telecommunications (1m exclusion)
Overhead services (Contact Service Owner) Oil/Gas (10m exclusion)
Other (including structures)
Declaration by the permit requester/receiver

I _______________________ representing ___________________________________, hereby declare that I have


checked the location and workers has been briefed about the emergency procedure and toolbox meeting given.
Date: Name and Sign:
Section IV - Approval

Reviewed by HSE Offi cer/Manager (SUMEC) Name: Sign: Date:

Work shall be carried out only after complying with the precautions given in the section III of permit

Approved by Project / Site Manager Name: Sign: Date:


Section V - Work Permit Closed

This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)

Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign


Date: Date: Date: Date: Date: Date: Date:

Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign


Date: Date: Date: 13 Date: Date: Date: Date:
REMARKS:
Excavation Work Permit
An excavation work permit is a necessary document that must be obtained before starting any
digging or excavation activities. This permit is required for various purposes, such as building
infrastructure. The main goal of obtaining an excavation work permit is to ensure the safety of the
workers and the surrounding environment by minimizing the potential risks associated with
excavation activities.

Some common risks involved in excavation work include:


 Falling into the excavation site.
 Being trapped or engulfed by collapsing soil or materials.
 Accidental explosions are caused by striking underground utilities or improperly stored
explosives.
 Exposure to hazardous airborne contaminants, such as dust, asbestos, or other harmful
substances.
 Accidents result from the failure of temporary supports or battering.

Here are some examples of excavation permits:


 Trenching permit: This permit is required when excavating a narrow excavation below the
ground’s surface. Trenching permits are typically required for utility installation, sewer line
repair, and other similar activities.
 Excavation permits for foundations: This permit is required when excavating for a foundation of
a building or structure. It is important to ensure that the foundation is constructed on solid
ground and that the excavation work is done in a safe and controlled manner.
 Excavation permits for underground storage tank, such as petroleum products or hazardous
waste. Excavation work for underground storage tanks should be done cautiously to prevent
spills or leak.

14
ELECTRICAL
PERMIT

15
Rev. No. 002

49MWAC CORDON SOLAR POWER PROJECT

ELECTRICAL PERMIT PTW Control Number: SUMEC-HSE-

Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
Details of the 220 volt power tool ✔for Yes and X for NO Y/N N/A
Types of Power Tool ELCB tested and certified
Drill £ Breaker £ Others £ Industrial sockets (blue) in use
Reason for using the equipment:
Armored cable
Toolbox talk on use of 220 volt elec.
Equipment is adequately earthed
Safety warning signs in place
Dead Man's switch functioning
Manufacture
Double insulated casings

Serial No. Area of work kept dry


Cables appropriately protected
Declaration by the permit requester/receiver

I _______________________ representing ___________________________________, hereby declare that I have


checked the location and workers has been briefed about the emergency procedure and toolbox meeting given.
Date: Name and Sign:
Section IV - Approval

Reviewed by HSE Offi cer/Manager (SUMEC) Name: Sign: Date:

Work shall be carried out only after complying with the precautions given in the section III of permit

Approved by Project / Site Manager Name: Sign: Date:


Section V - Work Permit Closed

This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)

Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign


Date: Date: Date: Date: Date: Date: Date:

Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign


Date: Date: Date: 16 Date: Date: Date: Date:
REMARKS:
Electrical Work Permit
An Electrical Work Permit is a document issued to authorized personnel to perform electrical work
on a specific circuit or equipment. The permit is issued to ensure that proper safety measures are in
place to prevent electrical accidents and injuries.

Examples of electrical work that may require an Electrical Work Permit include:
 Installing or repairing electrical equipment may include installing or repairing motors,
generators, transformers, switch gear, or control panels. A permit ensures that proper safety
measures, such as locking and tagging out the equipment, are in place to prevent accidental
contact with live electrical parts.
 Electrical maintenance may include cleaning, lubricating, testing, or adjusting electrical
equipment. A permit ensures that proper safety measures, such as wearing appropriate PPE
and using proper tools, are in place to prevent electrical shocks and burns.
 Troubleshooting electrical problems may involve testing or measuring electrical circuits or
equipment to diagnose problems. A permit ensures that proper safety measures, such as de-
energizing the equipment and using proper test equipment, are in place to prevent electrical
accidents.
 Modifying electrical systems may include adding or removing electrical circuits, changing wiring,
or upgrading equipment. A permit ensures proper safety measures, such as disconnecting and
isolating the equipment, are in place to prevent electrical hazards.
 Testing and commissioning electrical systems may involve testing newly installed equipment or
systems to ensure they function properly. A permit ensures proper safety measures, such as
using proper test equipment and following testing procedures, are in place to prevent electrical
accidents.

17
CONFINED
ENTRY SPACE
PERMIT

18
Rev. No. 002

49MWAC CORDON SOLAR POWER PROJECT

CONFINED ENTRY SPACE PERMIT PTW Control Number: SUMEC-HSE-

Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Atmosphere in the confined space tested If so, are the equipments isolated
Oxygen level is 19.5% (should not be less/more) Is the main source of supply tagged?
Will the atmosphere be monitored during work? Has the toolbox talk been given?
Continuously/Periodically specify interval Air intake system located free from fume
Has the space been ventilated before entry Preparedness for emergency response?
Will ventilation be continued during work?(LEV) Work method statements submitted?
Was the space foubd unacceptable? Will any chemicals be used in the space?
If so, after ventilation was the area retested? Adequate illumination to carry out job?
Are there any other equipment running? Appropriate PPE provided
Will any other equipment be used in the space? Watcher/s required
Declaration by the permit requester/receiver

I _______________________ representing ___________________________________, hereby declare that I have


checked the location and workers has been briefed about the emergency procedure and toolbox meeting given.
Date: Name and Sign:
Section IV - Approval

Reviewed by HSE Offi cer/Manager (SUMEC) Name: Sign: Date:

Work shall be carried out only after complying with the precautions given in the section III of permit

Approved by Project / Site Manager Name: Sign: Date:


Section V - Work Permit Closed

This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
19
REMARKS:
ENTRY LOG
Attendant (s): Confined Space Name:

Responsible Engineer: Responsible Safety Officer:

Time In Time Out


Name (Person Entering) Date Remarks
(Initials) (Initials)

ON-SITE RESCUE PLAN


20
Confined Space Name/Location: Date:

Attendant:

On-Site Rescue Personnel/Designation:

Methods of Communication: Attendant to Rescue Personnel: Phone Radio


Attendant to workers: Phone Radio Visual Hand Signal Rope Signal

Methods of Rescue: External (Retrieval) Internal: Congested:


O Hauling System Required: O Patient lowering system required/lowering area:
O Anchor overhead:
Anchorage: Beam Stairwell Support Column Other:

Rescue Equipment Requirements (check  where applicable below and indicate quantity needed):
Hauling Systems: Carabiners: Pulleys: Shock absorbers/lanyards: Anchor
Straps: Webbing: Ascenders: Body Harnesses:
Rigging Plates: Safety Lines: Main Lines: Wrist/Ankle Harnesses:
O Fire Extinguishers: Others:
Rescue Equipment Inspections
Identified rescue equipment inspected by competent worker: Company: Record
Yes No

Medical Equipment Requirements (check  where applicable below and indicate quantity needed):
First Aid Kit: O Other Device:

Additional PPE Requirements (Indicate what is needed):


High Visibility Vests Hearing Protection Safety Shoes/Boots Hard Hats Safety Glasses/Goggles
Gloves Face Shield Others

Description of Space (include location of attendant):

Diagram of Space (Use Back of Page if needed):

Completed by: O Entry Supervisor O Attendant O Other: Date:

21
ON-SITE RESCUE
PROCEDURES
These Procedures and the associated On-Site Rescue Plan are part of the written plan for the confined space
and are based on an evaluation of the risks in this area.

Prior to entry and/or work in the confined space:

1. The associated "on-site rescue plan" for the confined space must be completed, and the entry
supervisor must make sure that all the rescue tools needed to carry out a rescue inside the confined
area are on hand.

2. The entry supervisor will make sure that there are adequate qualified individuals on hand to carry
out these on-site rescue procedures for the confined area as specified in the "on-site rescue plan"
that is attached.

3. Subcontractor to coordinate with SUMEC personnel from time to time of operations.

4. Using the methods outlined in the "on-site rescue plan" attached, the attendant initiates
communication with all employees.

On entry and while working in the confined space:

1. According to the attached "on-site rescue plan," the attendant who is stationed outside and close to the
restricted space's entrance keeps in constant contact with all employees inside the area.

2. The attendant must be notified immediately if an entrant recognizes:

- unusual action/ behavior


- an unexpected hazard
- an unsafe act or
- detects a condition prohibited by the permit

3. Entrants must exit the confined space as quickly as possible, when:

- an order to evacuate is given by the attendant or entry supervisor


- an entrant recognizes a sign or symptom of over-exposure
- an unacceptable condition arises or
- an evacuation alarm is

activated. In the event of a confined

space rescue:

The attendant does not enter the confined space but immediately summons a rescue response from the on-
site rescue team, using the means of communication described in the attached “on-site rescue plan”.

22
Confined Entry Space Permit
A Confined Entry Space Permit is a formal document granting permission to work within a
confined space. Confined spaces are areas that are large enough for a person to enter and
perform work but have limited means of entry and exit and are not designed for continuous
occupancy. These spaces can present a variety of hazards, such as toxic atmospheres,
oxygen deficiency, engulfment, or entrapment, which can lead to serious injury or fatality if
not properly managed.

The main objectives of a Confined Entry Space Permit are to:


 Identify and assess potential hazards associated with the confined space.
 Establish appropriate safety measures, including ventilation, gas monitoring, and rescue
procedures.
 Verify that the individuals involved in the work are adequately trained and competent
to work in confined spaces safely.
 Ensure proper communication and coordination among workers, supervisors, and
rescue personnel.
 Maintain a record of all confined space work activities for future reference and
regulatory compliance.

Some examples of tasks that may require a Confined Entry Space Permit include the
following:
 Cleaning or maintenance of tanks, vessels, or silos: These confined spaces may contain
hazardous chemical residues or lack adequate ventilation, leading to dangerous
atmospheres. A confined entry space permit ensures that all safety protocols are
followed, such as purging and isolating the space, ventilating the area, and using gas
monitors to detect hazardous atmospheres.
 Inspection, repair, or maintenance of sewers or underground utility vaults: These spaces
can present risks such as engulfment, oxygen deficiency, or toxic gases. A confined
space permit ensures workers know the hazards, wear appropriate PPE, use gas
monitors, and follow proper entry and exit procedures.
 Working inside pipelines, ducts, or tunnels: These confined spaces can have limited
access and egress, making it difficult for workers to escape in an emergency. A confined
space permit ensures that proper communication and rescue procedures are in place
and that workers are trained to work safely in these environments.

23
HOT WORK
PERMIT

24
Rev. No. 002

49MWAC CORDON SOLAR POWER PROJECT

HOT WORK PERMIT PTW Control Number: SUMEC-HSE-

Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Flammable materials removed from location Appropriate working platform
Welding genset terminal insulation Safety warning signs in place
Adequate Earthling Adequate ventilation
Area of work clean and dry Condition of the welding cables
Appropriate fire extinguisher provided Adequate illumination
Operatives trained in using fire extinguisher Flashback arrestor - gas cylinder
Fire blankets (non-flammable) provided Cylinder in trolley and secured
Fire watch personnel Regulator in good condition
Area barricaed Gas test required
Appropriate PPE provided Isolation of equipment required
Declaration by the permit requester/receiver

I _______________________ representing ___________________________________, hereby declare that I have


checked the location and workers has been briefed about the emergency procedure and toolbox meeting given.
Date: Name and Sign:
Section IV - Approval

Reviewed by HSE Offi cer/Manager (SUMEC) Name: Sign: Date:

Work shall be carried out only after complying with the precautions given in the section III of permit

Approved by Project / Site Manager Name: Sign: Date:


Section V - Work Permit Closed

This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)

Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign


Date: Date: Date: Date: Date: Date: Date:
25
Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign
Date: Date: Date: Date: Date: Date: Date:
REMARKS:
Hot Work Permit

A Hot Work Permit is a formal document that grants permission to perform work involving
open flames, sparks, or other high-temperature sources. Hot work includes activities such
as welding, cutting, brazing, grinding, and other similar tasks that generate heat, sparks, or
flames. These activities can present significant fire and explosion hazards, leading to serious
injury or damage to property if not properly managed.

The main objectives of a Hot Work Permit are to:


 Identify and assess potential fire and explosion hazards associated with the hot work
activity.
 Ensure that the individuals involved in the hot work activity are adequately trained and
competent to perform the work safely.
 Establish appropriate safety measures, including fire prevention and control,
ventilation, and personal protective equipment (PPE).
 Verify that the work area is free of flammable materials and that proper safeguards,
such as fire blankets or extinguishers, are in place.
 Maintain a record of all hot work activities for future reference and regulatory
compliance.

Here are some examples of tasks that may require a Hot Work Permit:
 Welding or cutting metal structures or equipment involves using an open flame or arc to
join or cut metal parts or structures. A hot work permit ensures proper fire prevention
measures, such as removing flammable materials from the work area and using fire
blankets to contain sparks.
 Grinding or sanding of metal surfaces: Grinding or sanding metal surfaces generates
heat and sparks, which can ignite flammable materials in the work area. A hot work
permit ensures proper ventilation, and PPE is used to minimize the risk of fire or
explosion.
 Brazing or soldering of pipes or other components: These activities involve using heat to
join metal components without melting them. A hot work permit ensures that proper

26
fire prevention measures are in place and that workers use appropriate PPE and
ventilation.
 Thawing of frozen pipes: Using heat sources such as torches can create fire hazards due
to flammable materials in the work area. A hot work permit ensures proper safety
measures, such as heat-resistant shields and PPE, are in place to minimize the risk.
 Roofing work involving torches: Torch-applied roofing involves using open flames to seal
and install roofing materials. A hot work permit ensures proper fire prevention and
control measures, such as fire-resistant roofing materials, fire extinguishers, and fire
watchers.
 Demolition work involving cutting or burning of materials: Demolition work involving
cutting or burning of materials can generate heat and sparks, which can ignite
flammable materials in the work area. A hot work permit ensures proper safety
measures, such as removing flammable materials from the work area and using
appropriate PPE and ventilation.
 Heating or thawing equipment or pipelines involves using heat to thaw or warm
equipment or pipelines, which can pose a fire hazard if proper safety measures are not
in place. A hot work permit ensures workers use appropriate PPE and fire prevention
measures, such as fire-resistant blankets and fire extinguishers.

27
LIFTING
PERMIT

28
Rev. No. 002

49MWAC CORDON SOLAR POWER PROJECT

LIFTING PERMIT PTW Control Number: SUMEC-HSE-

Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Lifting procedure/prepared/planned? Doors and windscreen good condition
Crane inspected/Jibs good condition Main brake system funtioning
Work area in safe-condition Safety/Warning signs in place
Lifting calculation completed/Load Test/Charts Winch brake system functioning
Dedicated signalman (one person only) with vest Ground stability checked
Area supervisor/safety personnel supervision Stability of crane outriggers
Height clearance completed Weather in good condition
Shackles inspected Fire extinguisher in place
Sling inspected with certificates Steel plates (where required)
Spreader bar inspected Area barricaded
Declaration by the permit requester/receiver

I _______________________ representing ___________________________________, hereby declare that I have


checked the location and workers has been briefed about the emergency procedure and toolbox meeting given.
Date: Name and Sign:
Section IV - Approval

Reviewed by HSE Offi cer/Manager (SUMEC) Name: Sign: Date:

Work shall be carried out only after complying with the precautions given in the section III of permit

Approved by Project / Site Manager Name: Sign: Date:


Section V - Work Permit Closed

This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)

Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign


Date: Date: Date: Date: Date: Date: Date:

Name/Sign Name/Sign
29
Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign
Date: Date: Date: Date: Date: Date: Date:
REMARKS:
LIFTING PLAN
MATERIALS TO BE LIFTED: ____________________________________________________________

A. LOAD/LIFT CONDITION: New Used E. LIFT ARRANGEMENT

B. WEIGHT
1. Empty / Load kg 1. Number of Parts of Cable
2. Allowance for Unaccounted 2. Size of Cable mm
Material in Equipment kg 3. Lenght of Boom m
3. Other Misc. (Water, Concrete, 4. Angle of Boom at Pick-up
Refractory, etc.) kg 5. Angle of Boom at Set
4. Headache Ball kg 6. Capacity of Crane, Severest
5. Block kg Lifting Conditions (from chart)
6. Lifting Bar / Spreader Bar kg a. Over Rear kg
7. Slings & Shackles kg b. Over Front kg
8. Jib: Erected Stowed kg c. Over Side kg
9. Headache Ball on Jib kg d. Capacity of Crane This Lift
10. Cable (Main Fall) kg (from chart) kg
e. Max. Load of Crane kg
TOTAL WEIGHT kg f. This Lift's Percentage of
Crane's Rated Capacity %

C. SIZING OF SLINGS F. CRANE PLACEMENT


1. Sling Selection 1. Any Deviation From Smooth
a. Type of Arrangement Solid Foundation in the Area?
b. Number of Slings 2. Electrical Hazards in the Area?
c. Sling Size 3. Obstruction to Lift or Swing?
d. Sling Length 4. Boom Swing Direction & Degree
e. Rated Capacity of Sling
2. Shackle Selection G. PRELIFT CHECKLIST Yes No N/A
a. Capacity (tons) 1. Matting Acceptable
b. Shackle Attached to Load by 2. Outriggers Fully Extended
(Hitch Lugs, etc.) 3. Crane in Good Condition
3. Jib 4. Swing Boom
a. Is Jib to be Used? 5. Head Room Checked
b. Length 6. Max. Counterweights Used
c. Angle 7. Tag Line Used
d. Rated Capacity (fr. Chart) 8. Experienced Operator
9. Experienced Signalman
D. CRANE 10. Experienced Rigger
1. Crane Manufacturer 11. Load Chart in Crane
2. Model Number. 12. Load Chart Attached
3. Boom Configuration 13. Lift Drawings Required
4. Counter Weight Used 14. Wind Conditions
5. LMI Installed. 15. Crane Inspected
By: Date:
16. Functional Test of Crane
By: Date:

30
Lifting Permit
A Lifting Permit is a formal document granting permission to work with a crane or other
lifting equipment. Cranes and other heavy lifting equipment are commonly used in
construction, manufacturing, and shipping industries, where large or heavy loads must be
moved or positioned. Operating cranes and lifting equipment can present significant
hazards, including the risk of loads falling, equipment failure, or structural collapse, leading
to serious injury or fatality if not properly managed.

The main objectives of a Lifting Permit are to:


 Identify and assess potential hazards associated with the crane operation, such as
equipment malfunction, load instability, or nearby obstacles.
 Ensure that the crane operator and other personnel involved in the lifting operation are
adequately trained and competent to perform the work safely.
 Establish appropriate safety measures, including load calculations, rigging inspections,
and communication protocols.
 Verify that the crane and lifting equipment is properly maintained, inspected, and
certified as required by regulations and manufacturer recommendations.
 Maintain a record of all crane work activities for future reference and regulatory
compliance.

Some examples of tasks that may require a Lifting Permit include:


 Lifting heavy equipment or materials could involve lifting and positioning large
machinery, structural components, or other heavy loads at a construction site or
manufacturing facility. A crane work permit ensures that the operator knows the load’s
weight, the center of gravity, and other factors that may affect its stability during the
lift.
 Working near power lines or other overhead obstacles: Crane operations near power
lines or other overhead obstacles present the risk of contact, which can result in
electrocution or equipment damage. A crane work permit ensures that appropriate
safety measures, such as maintaining minimum clearance distances and using signal
persons or warning devices, are in place to minimize the risk.
 Lifting personnel using a crane or hoisting equipment: When personnel is lifted using a
crane or other hoisting equipment, there is an increased risk of injury due to falls or
equipment failure. A crane work permit ensures proper safety measures, such as using
approved personnel lifting devices and following manufacturer guidelines for personnel
lifting, are in place.

31
WORK AT
HEIGHT
PERMIT

32
Rev. No. 002

49MWAC CORDON SOLAR POWER PROJECT

WORK AT HEIGHT PERMIT PTW Control Number: SUMEC-HSE-

Inclusive Dates; From: ____________ To: _____________ Time; From: ________________ To: _____________
Location:
Description of Work:
Equipment to be use:
Power tools/Hand tools to be use:
Section I - Details of the Permit Receiver/Issuer
Name: Contact No. Sign
Permit Requester /
Name: Contact No. Sign
Receiver
Safety Offi cer Name: Contact No. Sign
Site Engineer Name: Contact No. Sign
Permit Issuer Project / Site
Name: Contact No.
(SUMEC) Manager Sign
HSE
Name: Contact No.
Offi cer/Manager Sign
Section II - Extended Working Hours (OVERTIME)
Date Start End Date
Start Extended Time End Time
Permit Contents ORA/JHA OMOS OTOOLBOX TALK OOTHERS____________________________________________
Section III - Prerequisite (Work maybe stopped if one of the following is not complied with)
✔for Yes and X for NO Y/N N/A ✔for Yes and X for NO Y/N N/A
Erected by certified scaffolder All board in the working platform firmly secured
with holding clamps?
Is the scaffold strong enough for the load? Has the scaffold been tied with existing features/
structure for stability?
Is the scaffold stable? Access ladder or Safe equivalent provided & used?
Condition of tubes, ladders and board Ladder & working area kept free of debris,
chemical, grease etc
Foundation, ground condition suiltable for the Complete platform, planks, close together &
erection of the scaffold? overlapped by at least 0.3 Mt or secured by wire
or proper cleating
Have all standards been erected on base plates? Guard rails/ handrails, mid rails and toe boards
installed on all open sides of platforms 1 Mt. over
in height
Are timber sole plates provided to prevent Scafft ag been signed and displayed indicating safe
sinking?
Are all standards fixed in true plumb? Training inductionof workers completed
Is the bracing between the standards correctly Toolbox Attendance/Meeting conducted
and rigidly fixed?
All couplers and joining pins correctly and rigidly Access/egress clear of obstruction.
fixed?
Declaration by the permit requester/receiver

I _______________________ representing ___________________________________, hereby declare that I have


checked the location and workers has been briefed about the emergency procedure and toolbox meeting given.
Date: Name and Sign:
Section IV - Approval

Reviewed by HSE Offi cer/Manager (SUMEC) Name: Sign: Date:

Work shall be carried out only after complying with the precautions given in the section III of permit

Approved by Project / Site Manager Name: Sign: Date:


Section V - Work Permit Closed
This is to certify that I am satisfied that all works have been completed, the area was left clean and tidy, and materials and waste have been
removed.
Position Name Signature Date
Permit Requester/Receiver
Permit Issuer
Permit Coordinator
Permit Re-validation (SUMEC HSE Officer)

Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign


Date: Date: Date: Date: Date: Date: Date:

33
Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign Name/Sign
Date: Date: Date: Date: Date: Date: Date:
REMARKS:
Work At Height Permit
Work at height permit is a document that must be completed and authorized before any
work activity can occur at the height of more than two meters above the ground. The permit
is designed to ensure that all necessary precautions have been taken to prevent falls, ensure
workers’ safety, and comply with legal requirements.

Examples of work that requires a height work permit include, but are not limited to:
 Working on ladders: Ladders are commonly used to access high places like roofs or
shelves. Any work carried out on a ladder more than two meters above the ground will
require a height work permit.
 Working on scaffolding: Scaffolding is commonly used in construction work to provide a
stable platform for workers to access high areas. Any work carried out on scaffolding
over two meters above the ground requires a height work permit.
 Working on Mobile Elevated Work Platforms (MEWPs): MEWPs are commonly used in
construction, maintenance, and cleaning work to provide access to high areas. Any work
carried out on a MEWP more than two meters above the ground will require a height
work permit.
 Working on roofs: Any work carried out on a roof over two meters above the ground
will require a height work permit.
 Working near edges or openings: Work carried out near edges or openings more than
two meters above the ground, such as balconies, windows, or open floors, will require a
height work permit.
 Using access equipment: Any use of access equipment, such as cherry pickers or hoists,
to carry out work more than two meters above the ground will require a height work
permit.

34
EQUIPMENT
CHECKLIST

Equipment Name & Number: BACKHOE LOADER


35
Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description M T W TH F SAT SUN

1. Machine should be physically good & certified by #


competent authority.
2. No damage in tire (Bolts, crack, cuts & air pressure, etc.). #
3. Head & tail light and indicators are in working condition. #
4. Side mirror should be in good condition. #
5. Wind shield/glass should be in proper condition. #
6. Wiper should be in running condition. #
7. Operator cabin and driver seat should be made by good #
& sound quality of material.
8. Hydraulic cylinders and hoses are in good condition and #
free from leakage.
9. Outrigger should be free from damages. #
10. Red triangle/reflective tape should be fixed in front of #
vehicle.
11. Front & reverse horn. #
12. Fire extinguisher in operator cabin. #
13. First aid box in operator cabin. #
14. Operator have valid and suitable license. #
REMARKS:

Equipment Name & Number: EXCAVATOR


Note: Please write Yes or No in the given box and if some comments write in remarks column.
36
SN. Description M T W TH F SAT SUN

1. Engine and rotating part should be properly covered. #


2. Track frame should be in good and working condition. #
3. Crawler belt and shoes should be in good condition. #
4. Boom and arm should be free from defects like #
corrosion, bend, etc.
5. Hydraulic cylinder and hoses should be in good #
condition.
6. Bucket, cutter pins should be free from defects, e.g., #
damage, corrosion, bend, etc.
7. Teeth should be free from defects, e.g., damage, #
corrosion, bend, etc.
8. Side mirror should be in good condition. #
9. Head & tail light and indicators are in working #
condition.
10.Wind shield/glass should be in proper condition. #
11.Wiper should be in running condition. #
12.Swing horn should be in good condition. #
13.Fire extinguisher in operator cabin. #
14.Operator have suitable licence/experience certificate. #
REMARKS:

Equipment Name & Number: DUMPTRUCK


Note: Please write Yes or No in the given box and if some comments write in remarks column.
37
SN. Description M T W TH F SAT SUN

1. Operator cabin should be fully covered and made by #


sound quality of material.
2. Carrier should be in good condition. #
3. No damage in tire (Bolts, crack, cuts & air pressure, etc.). #
4. Side mirror should be in good condition. #
5. Head & tail light and indicators are in working condition. #
6. Wiper should be in running condition. #
7. Wind shield/glass should be in proper condition. #
8. Seatbelt should be available. #
9. Red triangle/reflective tape should be fixed in front of #
vehicle.
10. Hydraulic cylinder and hoses should be in good condition #
and free from leakage.
11. Registration number should be written. #
12. Front & reverse horn. #
13. Fire extinguisher in operator cabin. #
14. Operator have valid and suitable license. #
15. First aid kit should be available. #
16. Normal break & emergency (hand) break should be in #
functional & operational condition.
Remarks:

Equipment Name & Number: ROLLER COMPACTOR


Note: Please write Yes or No in the given box and if some comments write in remarks column.

38
SN. Description M T W TH F SAT SUN

1. Earth compactor should be physically in good condition. #


2. No damage in tire (Bolts, crack, cuts & air pressure, etc.). #
3. No damage in compacting roller. #
4. Dangerous and moving part should be covered with fix #
guard.
5. Head & tail light and indicators are in working condition. #
6. Side mirror should be in good condition. #
7. Wind shield/glass should be in proper condition. #
8. Wiper should be in running condition. #
9. Front & reverse horn. #
10. Fire extinguisher in operator cabin. #
11. Operator have valid and suitable license. #
Remarks:

Equipment Name & Number: CONCRETE MIXER


Note: Please write Yes or No in the given box and if some comments write in remarks column.

39
SN. Description M T W TH F SAT SUN

1. Mixer machine should be physically fit. #


2. Rotating part & IC engine should be covered with fix #
guard.
3. No damage in tire (crack, cuts & air pressure, etc.). #
4. Rotating part of gear should be covered. #
5. Proper handle lock should be available. #
6. Handle should be free from defect. #
7. Mixer machine should be with proper handle to #
control the movement.
8. Spark arrestor should be installed, if machine is #
operating in flammable atmosphere.
Remarks:

Equipment Name & Number: TRANSIT MIXER


Note: Please write Yes or No in the given box and if some comments write in remarks column.
40
SN. Description M T W TH F SAT SUN

1. Transit mixer should be physically in good condition. #


2. No damage in tire (Bolts, crack, cuts & air pressure, etc.). #
3. Registration number should be written. #
4. Head & tail light and indicators are in working condition. #
5. Side mirror should be in good condition. #
6. Wind shield/glass should be in proper condition. #
7. Wiper should be in running condition. #
8. Red triangle/reflective tape should be fixed in front of vehicle. #
9. Rotatory part of secondary engine should be covered with fix guard. #

10. Rotating part of gear box should be covered by fixed guard. #


11. Inbuilt ladder should be proper with suitable guard. #
12. Front & reverse horn. #
13. Fire extinguisher in operator cabin. #
14. Operator have valid and suitable license. #
15. First aid kit should be available. #
16. Normal break & emergency (hand) break should be in functional & #
operational condition.
Remarks:

Equipment Name & Number: MOBILE CRANE


Note: Please write Yes or No in the given box and if some comments write in remarks column.

41
SN. Description M T W TH F SAT SUN

1. Physical condition of body should be in sound manner. #


2. No damage in tire (Bolts, crack, cuts & air pressure, etc.). #
3. Head & tail light and indicators are in working condition. #
4. Side mirror should be in good condition. #
5. Safe work load (SWL) marked. #
6. Hoist limit switch. #
7. Wire rope free from damage. #
8. Safety latch in hook. #
9. Outrigger with spreader mat should be in good and working condition. #

10. Sprit level should be installed. #


11. Boom condition while full extension (free from damage, crack & #
jamming, etc.).
12. No oil leakage in hydraulic part. #
13. Safe load indicator should be in working state. #
14. Front, reverse and swing horn. #
15. Fire extinguisher in operator cabin.
#
16. Operator should have valid and suitable license. #
17. Crane simulator should be in working condition. #
18. First aid kit should be available. #
19. Crane should be physically good & should have valid TPI. #
Remarks:

Equipment Name & Number: DIESEL GENERATOR

42
Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description M T W TH F SAT SUN

1. Physical condition of DG should be good. #


2. Door of DG should be in good condition, so that #
rotatory part of machine could cover.
3. Display panel should be in good condition. #
4. Emergency stop button should be mushroom headed #
with red colour.
5. DG should be grounded as per IS 3043:1987. #
6. Power supply panel provided with ELCB/RCCB/MCB. #
7. Spark arrestor should be installed, if DG is operating in #
flammable atmosphere.
8. Diesel tank should free from leakage. #
9. DG should be keep on aggregate/gravel stone. #
10. Keep CO2, BCP fire extinguisher/sand bucket near DG. #
11. Fitness and pollution certificate should be taken from #
competent authority.
12. DG operated by competent person. #
13. Spill observant kit or drip tray available. #
14. Insulated rubber mat available. #
Remarks:

Equipment Name & Number: GAS CUTTING SET


43
Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description M T W TH F SAT SUN

1. Cylinder should be kept in trolley. #


2. Always keep in upright position. #
3. Properly secured. #
4. Valve protection cap. #
5. Regulator should be free from any defect. #
6. Pressure gauge should be in proper condition. #
7. Provide flash back arrestor. #
8. Provide industrial clip. #
9. Hose condition should be good with colour coded. #
10. Joint should be firm and free from defect, e.g., oily, rust & #
leakage, etc.
11. Torch should be in good condition. #
12. Use proper PPEs for the Job, e.g., Leather hand gloves & safety #
goggles, etc.
13. Keep fire extinguisher at working place. #
14. Provide booth, made by fire retardant material (if required). #

15. Work carried out by competent person.


#
Remarks:

Equipment Name & Number: WELDING MACHINE

44
Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description M T W TH F SAT SUN

1. Welding machine should be in good and working #


condition.
2. Power cable should be free from damages and #
connection taken through industrial plug and .
3. Switches should be free from defects, e.g., #
uninsulated & damages, etc.
4. Welding led & return led connection should be tightly #
by means of lugs/socket.
5. Welding led & return led should be free from #
damages, e.g., cuts, naked, too many joint, etc.
6. Welding holder should be in good condition and free #
from metal contact.
7. Earthing holder should be in good condition and free #
from rust.
8. Welding machine should be grounded as per IS #
3043:1987.
9. Keep fire extinguisher at working place. #
10. Provide booth, made by fire retardant material (if #
required).
11. Work carried out by competent person. #
Remarks:

Equipment Name & Number: LIFTING TOOLS & TACKLES

45
Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description M T W TH F SAT SUN

1. Wire sling should be free from defects, e.g., #


corrosion, crack, cuts & oily, etc.
2. Use thimble for making I-shape. #
3. Wire rope should be knotted with proper clamp. #
4. Web sling should be free from defects, e.g., cuts, #
abrasion, knot, hole & oily, etc.
5. I-shape should be free from damages. #
6. D-shackle should be in good condition and its face #
should not expand more than 15% of its original
shape.
7. Suitable I-bolt should be used. #
8. Lifting tools & tackles should be used having suitable #
strength & capacity.
9. Lifting tools & tackles should be handle and store in #
safe manner.
Remarks:

Equipment Name & Number: FIRE EXTINGUISHER


Note: Please write Yes or No in the given box and if some comments write in remarks column.
46
SN. Description M T W TH F SAT SUN

1. Fire extinguisher always keep on trolley, it will be #


easy for movement.
2. Keep Sand bucket. #
3. Sand bucket should be covered to avoid mixing of #
foreign material.
4. Fire extinguisher should be kept at waist level height #
for quick access.
5. Fire extinguisher should be free from defects and #
regularly tested.
6. Inspection date and due date should be clearly #
marked.
7. Hose and hose connection are in good condition. #
8. Check pressure gauge at regular interval for any #
pressure drop.
Remarks:

Equipment Name & Number: GRADER


47
Note: Please write Yes or No in the given box and if some comments write in remarks column.
SN. Description M T W TH F SAT SUN

1. Machine should be physically good & should have valid #


TPI certificate.
2. No damage in tire (Bolts, crack, cuts & air pressure, etc.). #
3. Head & tail light and indicators are in working condition. #
4. Side mirror should be in good condition. #
5. Wind shield/glass should be in proper condition. #
6. Wiper should be in running condition. #
7. Canopy above driver seat should be made by good & #
sound quality of material.
8. Hydraulic cylinders should be in good condition and free #
from leakage.
9. Red triangle/reflective tape should be fixed in front of #
vehicle.
10. Front & revers horn. #
11. Fire extinguisher in operator cabin. #
12. Operator have suitable license. #
Remarks:

48
APPOINTMENT
LETTER

49
Permit Issuer Responsibilities
• The Issuer has the sole authority to issue the permit.
 • The Issuer shall be fully aware of site conditions, the type of work to be carried out
and all the requirements stated in the permit.
• The Issuer shall conduct an onsite inspection jointly together with the Receiver to
ensure that site conditions are safe to permit the work and all requirements stated in the
permit are implemented prior to the issuance of the permit.
 • The Issuer shall withhold the issuance of the permit if the requirements are not
met, or site conditions are not safe for the work to carry out.
• The Issuer shall, if noticing the presence of any other potential hazards, risks that
may jeopardize the safety of the worker, tools or equipment advice the Receiver of
appropriate countermeasures to be taken.
• The Issuer shall ensure that all required safety monitoring measurements are
properly done and so stated in the permit.
• The Issuer shall ensure all personnel involved in the work are fully aware of
Emergency procedures.
• Once informed the work is completed, the Issuer shall visit the site jointly with the
Receiver to ensure that the work is ceased and the site is kept clean and tidy without any
smouldering exist.

I ____________________, as a Permit Issuer hereby declare that I am aware of my


responsibilities and accept the consequences if accident happened on the working area by
my negligence.

_________________________________
Signature above printed Name
Date: ____________________

50
Permit Receiver Responsibilities
• The Receiver shall be fully aware of all requirements stated in the permit and
comply with them at all times.
 • The Receiver shall fully brief the work crew to ensure that requirements are clearly
understood by the crew under his supervision.
 • The Receiver shall ensure the work is performed in accordance with the conditions
specified in the permit. He shall remain at the work site to supervise the work.
 • The Receiver shall ensure that under no circumstances shall by his own discretion
or his crew change the original scope of the work, which is described in the permit.
 • Whenever site conditions are drastically changed, the Receiver shall immediately
stop the work and inform the Issuer of the change for further instruction from him.
 • Upon the occurrence of an emergency the Receiver shall immediately stop the
work and shut down all equipment.
 • The Receiver shall report the completion of the work or the expiration of the
validity of the permit to the Issuer and ensure that the site is kept clean and tidy without
any smouldering/ignition sources.
 • If the work in progress requires extending the validity stated in the permit, the
Receiver shall request an issuance of new permit.

I ____________________, as a Permit Receiver hereby declare that I am aware of


my responsibilities and accept the consequences if accident happened on the working area
by my negligence.

_________________________________
Signature above printed Name
Date: ____________________

51
HSE Permit Coordinator Responsibilities
• The HSE Permit Coordinator is responsible for daily coordination of the work
permits.
 • He is responsible for full clerical control of the system including retention of the
closed out Work Permits for one-week period.
 • Has the full overview of the planned, open and suspended work permits on visual
display in his permit to work office.

I ____________________, as a HSE Permit Coordinator hereby declare that I am


aware of my responsibilities and accept the consequences if accident happened on the
working area by my negligence.

_________________________________
Signature above printed Name
Date: ____________________

52

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