LIFTING WORK PERMIT (LWP)

JOB – NO: PERMIT NO:

JOB DESCRIPTION:

PERMIT VALID FROM: TIME:

PERMIT VALID UP TO: TIME:
DESCRIPTION OF WORKS:
A Safe Work Method Statement (SWMS), Job Safety Analysis (JSA) and/or Safe Work Procedure (SWP) has been provided and
is attached to this ‘work permit’ Yes No

1. Types of hazards associated with the job are:

Falling objects, Heavy lifting injuries, Slips, trips, and falls, Equipment malfunctions, Exposure to high noise levels,
Electrical hazards, Working at heights, Weather-related hazards, Struck-by incidents

2. Control Measures take:

TBT Meeting and external Training, Housekeeping, Barricades, Site Inspections, Lockout-tagout procedure, ELCB
Grounding, Full body Harnesses, Workers Rest Shelters, and PPE

3. I have approved the area for working at height by the following personal:
M/S Shinan Heavy Lifting LLC (Operators, Riggers and Supervisor)
I will ensure that the all safety measures are taken, maintained and in place as along as the workman work for lifting
operations. I have instructed the supervisor of shinaan heavy lifting llc and he has endorsed to follow all safety measures
by his workmen.

Supervisor / Foreman
Name: Signature: Date:

Authorizations

Permit Issued To:

(Project Engineer) Name & Emp# (Signature) (Date)

Permit Issued By:

(HSE Officer)
Name & Emp# (Signature) (Date)

Cancellation/completion of permit

Permit cancelled/returned by:

Name & Emp# (Signature)

Cancelled/returned at: am/pm On:

Reason for cancellation :

Note:
1. Permit copy shall be keep in work location.
2. Original to be retained by site Engineer and produced on request by any officer of AHC, consultant and clients.
3. Permit to be issued for a maximum of one week.
4. New permit to be issued on expiry.
5. Permit automatically gets cancelled if condition change.
6. Lifting accessories to be examined visually for defection by Supervisor/foreman before use.
7. Banks man should be identified
8. Work starts only by issuing the permit.