CHECK LIST FOR EXCAVATION (> 1mtr)

Area / Site / Location : Contractor :

Date and Time : Permit Ref. No. :

Sr. Yes /
Check Points Remarks
No No
1 Is Area cordoned?
2 Is traffic diversion board displayed & alternate road explored?
3 Are Fire & Safety, Security & Admistration departments
communicated?
4 Whether soil stability is checked?
5 In case of loose soil, whether proper shoring for the excavation is
provided to prevent cave-in for side of slope.
6 While excavating whether proper slope usually 450 or suitable
benches of 0.5 m width at each 1.5 m depth is provided?
7 Whether proper footstep, slope or ladder provided for safe
access/egress of man and equipment? In case excavation trench
> 1.2 m deep, at every 7.5 mtr ladder or other means provided
for access?

8 Whether barricading of 1m height with tape provided for

excavation having depth<0.6 m and with hard barrication for
depth> 0.6 m?
9 Whether excavating earth is placed beyond 1 m of the edge of
the trench?
10 Whether separate area identified for storage of excavated earth
or debris?
11 Whether heavy vehicle movement is restricted to come within 1
m of the edge of the excavation?
12 Whether necessary precaution is taken for underground pipes,
sewers, and cables by contractors? Manual excavation is done in
such case?
13 Whether proper arrangement has been made for bailing out
water if required?
14 Has rescue arrangements reviewed?
15 During rains whether the excavation is done with extra precaution
to prevent caving in?
16 Whether one person is available at all the time to communicate
any hazards noticed with workers working in deep trenches or
excavation? When depth exceeds 5 m how communication is
maintained?
17 In case of machineries used inside at least 0.5 mtr space
allowances in width after consideration of the throw of the
equipment & 1.1 mtr from the head roof of the vehicle for safe
access and egress for equipment & machineries used is
ensured?

18 Incase excavation is more than 5 m depth, has adequate

ventilation been ensured?
19 In case of lengthy excavation, the pass-over with at least two
gratings made?
20 Is provision of gumboots, safety helmet, hand gloves, safety
goggles, ear plug (while use of pneumatic hammer) ensured and
used?
21 Has JSA & RA for the job carried out & briefed to the workers
engaged?
Sign of Permit Issuer : Sign of the Permit Acceptor :
Name of Permit Issuer : Name of the Permit Acceptor :
 TATA CHEMICALS LIMITED, MITHAPUR.
CONFINED SPACE ENTRY CHECKLIST

Area / Site / Location : Contractor :

Date and Time : Permit Ref. No. :

Sr. Check Points Yes / Remarks

No No
1 Are all lines connecting with tank / reactor / vessel positively
isolated? Please attach schematic drawing showing isolation
arrangement.
2 Is tank / reactor / vessel free from any toxic / corrosive /
reactive material/ Radio active material ?
3 Is gas test done? If yes then write results of gas test
LEL (Not more than 10%): ________
NH3 (Not more than 25 PPM): ______
Cl2 (Not more than 1 PPM): ________
Others ------------------------- _________
4 Is ventilation inside the tank / reactor/vessel sufficient ?
5 Is level of oxygen measured inside the tank / reactor / vessel.
If yes, then specify level of oxygen (Should be between from
19.5% to 22.5%)
6 Is the temperature inside the tank / reactor / vessel comfortable
to work ?
7 Are all energy sources connecting with tank/reactor/ vessel
isolated? Name of Person: __________________
a Electrical energy
b Process Energy
c Mechanical energy
8 Is 24 Volt lamp / flamme proof torch provide inside the tank /
reactor / vessel?
9 Is no wet condition inside the tank / reactor / vessel
maintained for avoiding electrolution?
10 Is proper earthing to tank/reactor/ vessel provided & bonding
of pipes given ?
11 Is ladder provided for easy access in side the tank /
reactor/vessel, project outside to a height of 1050 mm and fit it
properly?

12 Is Safety harness / Safety belt providing for person entering

inside the tank / reactor / vessel and length of line sufficient?
13 Is the record maintained of person entering in to confined
space? Please mention name of responsible supervisor.
1. Name: ____________________ Sign: ___________
14 Is rescue arrangement reviewed for confined space entry and
provision made?
15 Is any person supervising the confined space activity? This is
included in Pt.13 & can be deleletd.
16 Are required Personal Protective equipments provided?
18 Are the persons trained for confined space entry?
19 Are the Job Safety Analysis / Risk Assessment done for
confined space entry & briefed to persons entering in to
confined space?

Sign of Permit Issuer : Sign of the Permit Acceptor :

Name of Permit Issuer : Name of the Permit Acceptor :
 TATA CHEMICALS LIMITED, MITHAPUR.
CONFINED SPACE ENTRY CHECKLIST

Area / Site / Location : Contractor :

Date and Time : Permit Ref. No. :

Sr. Check Points Yes / Remarks

No No
1 Is all line connecting with tank / reactor / vessel positively
isolate? Please attach schematic drawing showing isolation
arrangement.
2 Is tank / reactor / vessel free from any toxic / corrosive /
reactive material?
3 Is gas test done? If yes then write results of gas test
LEL (Not more than 10%): ________
NH3 (Not more than 25 PPM): ______
Cl2 (Not more than 1 PPM): ________
Others ------------------------- _________
4 Is ventilation inside the tank / reactor/vessel sufficient ?
5 Is level of oxygen measured inside the tank / reactor / vessel.
If yes, then specified level of oxygen (Should be between from
19.5% to 22.5%)
6 Is the temperature inside the tank / reactor / vessel extreme?
7 Are all energy sources connecting with tank/reactor/ vessel
isolated? Name of Person: __________________
8 Is 24 Volt lamp / flamme proof torch provide inside the tank /
reactor / vessel?
9 Is no wet condition inside the tank / reactor / vessel maintain
for avoiding electrolution?
10 Is proper earthing to tank/reactor/ vessel provided?
11 Is ladder providing for easy access in side the tank /
reactor/vessel and fit it properly?
12 Is Safety harness / Safety belt providing for person entering
inside the tank / reactor / vessel and length of line sufficient?
13 Is the record maintain of person enter in to confined space?
Please mention name of responsible supervisor.
1. Name: ____________________ Sign: ___________
14 Is rescue arrangement reviewed for confined space entry and
provision made?
15 Is any person supervising the confined space activity?
16 Are required Personal Protective equipments provided?
18 Are the persons trained for confined space entry?
19 Are the Job Safety Analysis / Risk Assessment done for
confined space entry & briefed to persons entering in to
confined space?

Name of Permit Issuer : Name of the Permit Acceptor :

 CHECK LIST FOR WORK AT NIGHT (WAN)

Area / Site / Location : Contractor :

Date and Time : Permit Ref. No. :

Sr. Yes / No
Check Points Comments / Confirmations
No
1 Planned/Emergency Work

2 Reason for work at Night

3 Type of Permit

4 Is it High Risk Jobs ?

6 Has the permit been properly issued ?

7 Has similar work done earlier ?

8 Has there been any Incident/Issues in Past on such

work ?
9 What special supervision is being provided ?
10 Are all check lists for safety properly completed ?
Is site specific Job Safety Analysis / Risk
Assessment prepared and attached ?
11 Have the engineers/technicians involved have
done such work earlier ?
12 Is the work being done by TCL staff or by persons
on contract ?
13 Has the contractor done such work earlier ?
14 Who is the empowered person to stake decision in
case of doubts ?
15 Has lighting / ventilation being provided ?

16 Is buddy (standby perosn ) provided to avoid lone

person working ?
17 Is video camera recording recommended and
provided ?
18 Are the person coming after proper rest ?

19 Have the person been checked for readiness to

work extending beyond 8 hours ?
20 Have the Fire / Safety / First Aid Posts informed
about the work ?

Name Signature Name

Permit Issuer
Permit Receiver
Plant Manager
GM-Operation
Safety Representative
 SAFETY CHEMICALS' BUSINESS

TITLE: DETAILS OF EMPLOYEES WORKING AT CONFINED SPACE / EXCAVATION WORK

Work Permit No. Name of Supervisor:

Location: Name of Standby person kept outside:

Department /
SR. Emp Dt. Dt. Dt. Dt.
EMPLOYEE NAME Contractor
NO. No.
G I st II nd III rd G I st II nd III rd G I st II nd III rd G I st II nd III rd

QSF-730-12-06 Rev.No.- '01 From Rev. Date : 18.06.07

 TATA CHEMICALS LTD. MITHAPUR
CHECKLIST FOR WORK AT HEIGHT

Area / Site / Location : Contractor :

Date and Time : Permit Ref. No. :

Sr. Yes /
Check points No
Remarks
No
1 Is work carried out at more than 7 Mtr height?
Are full body harness with double latch self-locking snap
2
hook being used?
3 Is length of lifeline accepted (1.8 mtr)? Not clear
4 Has proper anchor point for the safety line been located?
Has the fall arrest equipment been visually checked for
5
damage or defects?
Is fall arrest equipment in use that will limit the free fall to 2
6 meters or less?

Have all workers who work at heights been assessed as

7 competent & closely supervised by someone who is
competent?
Have all workers who are to work at heights have
7a undergone required medical tests like BP,vision & depth
perception test ?
Is work carried at height with help of ladder / scaffolding /
8
Temporary platform? Please specify details.
Is work carried out at height with help of scaffolding?
9
Please attached scaffolding checklist.
Has Safe Working load of temporary platform been
10 assessed & displayed?

11 Are Persons aware about the surrounding area hazards?

12 Are persons trained for work at height?
Are the Job Safety Analysis / Risk Assessment done for
13
work at height & briefed to persons engaged in the job?

Sign of Permit Issuer : Sign of the Permit Acceptor :

Name of Permit Issuer : Name of the Permit Acceptor :
 SAFETY
TITLE :CHECK LIST FOR SCAFFOLDING

Plant Area:
Location
Name of Contractor : Contractor Supervisor:
Date Scaffold Serial No.

Sr. Yes /
CHECK POINTS Remarks
No No
1 Has the request for scaffolding been signed by Authorised person ?
2 Is the scaffolding area effectively barricaded during erection / usage ?
3 Are base plates provided ?
Is the ground level firm, or have proper supports been placed under the
4
structure ?
5 Is safe access to equipment for emergecy egress restricted by scaffold ?
Is there min. 300mm gap maintained between scaffolding and any small
6
bore line / cable trays / instrumentation control boxes and valves.
Are the scaffolding in plumb and level ? The bay length maintained as per
7
the maximum intended load.
Are the poles, legs or uprights of scaffolding are securely braced to
8
prevent swaying / displacement ?.
Are free standing scaffolding tower protected from toppling by guying or
9
other means ?
10 Are adequate bracings provided ?
11 Are all the scaffold tubes in good condition ?
Is there a safe and convenient means of access ? If a ladder is used, is it
12 rising atleast 1050 mm above the platform ? Are the ladder resting on firm
base. ?
Are landing platforms provided for access ladders at more than 9 meters
13
height ?
14 Are the gratings / boards placed in order without undue gaps and tied ?
15 Is every work platform fitted with hand rail, knee rail and toe guard ?
16 Are the scaffolding erected as per the load duty requested ?
Has the certificate of fitness of scaffolding been signed by scaffolding
17
competent person?
18 Are the relevant status boards (tags) attached to the scaffolding ?
19 Any deviations to above is accepted ?
20 Are excess materials cleared up and returned to the yard ?
21 Measurement - Length ____ x width ___ x Height ______ = M3 _____
Are the Steel Tubes of heavy class welded or seamless tubes of 40mm
22
nominal bore conforming to IS:1161-1963.
23 Is JSA & RA Carried out & briefed to workers engaged?

Acceptance
Scaffolding engineer Engineer (Acceptor)
Sign : Sign :
Name : Name :
NOTE : Frequency of Inspection
a) Scaffold should be inspected before first use and within every 15 days.
b) Scaffold should be inspected after alteration or repair; and
c) Scaffold should be inspected after any event likely to affect the stability of the scaffold (for
 example, following strong winds or storms).
QSF- ____ -_____ 01 Rev. Date :10.11.06
 Check List for Lifting Operation (>5 ton)

Area / Site / Location : Contractor :

Date and Time : Permit Ref. No. :

Sr. Points Y/N/NA Remark

No
1 Is weather condition & wind velocity normal to do the job?
2 Method of lifting is through chain pulley / crane /electrical winch &
checklist for the same is filled & attached.
3 Whether lifting sketch / plan prepared & approved by concern
engg?
4 Determination of position of Centre of Gravity
5 Is suitable & certified lifting tackles selected?
6 Is experienced signalman deployed?
7 Are skilled workers deployed?
8 Is superviosn ensured throgh experience staff.
9 Is Area cordoned off?
10 Whether JSA and RA for the job carried out & briefed about the
hazards associated & their control measures?
11 Is lifting involve any inclination of the job?
If yes – What are additional controls to avoid over loading
12 Whether precautions have been taken in case of obstructions for
load as well as tag line?
13 Whether any suspension involved, if 'Yes', Whether the condition
of the suspension method is checked.
14 Is stand by arrangement made to ensure no one is near & under
the suspended load?
15 Any standby lifting tools & tackles required & arranged?
16 Is illumination checked for lifting job?
17 Availability of guy rope – if applicable
18 Protection of slings against sharp edge?
19 Is Area cordoned off? Repeatation of Pt.9

Sign of Permit Issuer : Sign of the Permit Acceptor :

Name of Permit Issuer : Name of the Permit Acceptor :