Doc No.

AP/SFT/105/WPS/GE

ADVENT PROJECTS & CONSULTANCY SERVICES PVT. LTD. Rev 01

GENERAL WORK PERMIT

Date & Time- Permit no-

Project Name-

Name of Sub Contractor-

Area & Location-
Date & Time of Work Start-
Date & Time of Work Finish-
Tools and Equipment involved-
Description of General work-

Note: In case of any hot work, excavation works, working at height or

NOTE
at confined space entry ensure relevant work permit has been issued.
Details Sub-Contractor Area in-charge/Engineer
Name
Signature
Date
This permit does not relieve user from responsibility with respect to
NOTE safety precautions, user must fully understand the site conditions,
validity of permit, personally checked by permit issuer and user.
SAFETY CHECKLIST BEFORE COMMENCEMENT OF WORK Yes/No/NA
All sources of electricity, utility are isolated and tagged "Do Not
1
Operate"
Space cleaned and barricaded and appropriate signage placed (work in
2
progress etc.)
Signal man present for movement of earth moving / heavy vehicles (if
3
required)
Communication checked between Supervisor and attendant (List
4
how______________________)
5 Check presence of reverse horn in vehicles used
6 Appropriate PPE’s worn.
7 Adequate general & operational lighting available.
Exits, walk ways, stair ways, Aisles etc. are unobstructed and
8
illuminated properly.
9 Fire extinguishers are visibly located and inspected.
10 Appropriate Tools available and are in good working condition.
Flammable and hazardous substances kept away from normal and
11
working spaces.

PPE’s & Other PPE’s & Other

Yes/No/NA Yes/No/NA
Requirements Requirements
Helmet Safety Net:
Safety Belt: Barricade the construction site:
Ear Muffs / Ear Plugs: Scaffolding required
Hand Gloves– Safety Guide rope required
Safety Goggles Fire extinguishers:
Safety Shoes Lockout and Tag out :
Breathing apparatus Masks:
Advent Projects and Consultancy services Pvt. Ltd. Pune|India
 Doc No. AP/SFT/105/WPS/GE

ADVENT PROJECTS & CONSULTANCY SERVICES PVT. LTD. Rev 01

GENERAL WORK PERMIT

Highlighted jackets Others

Remarks /additional safety measures required if any:-

COUNTER SIGNATURES
I have received a copy of this permit and have understood it. I undertake to follow all the
precautions specified. (VENDOR TEAM)

Name of Project Safety Engineer:________________________Signature:_________________

Name of Project Manager/Engineer:______________________ Signature:_________________

APPROVED BY APCSPL TEAM:

Name of the Project Engineer : __________________________Signature:_________________

Name of Safety In charge: _____________________________Signature:_________________

RENEWAL & PERMIT BEYOND STIPULATED TIME :

Remarks if any-

Permit extended up to date & Time: ______________________________________________

Name of Safety In charge:_____________________________Signature:__________________

The job has been completed and inspected by safety department. All workmen have

been withdrawn; tools removed and job left tidy.

Remarks if any________________________________________________________________

Date & Time __Name: __________Signature: __

Advent Projects and Consultancy services Pvt. Ltd. Pune|India