LIFTING WORK PERMIT

Project: _________________________________ JSA Number __________________________________

Name of the Contractor _____________________ Date of permit issue ____________________________

Permit validity from___________ to____________ Permit Extension_______________________________

Location of Job: ___________________________ Type of Crane: Tower crane/F15/Telescopic Boom/ fixed Boom Weight and

Dimensions of the lifting Component: __________________________________________________

Details of Materials to be loaded / lifted: __________________________________________________________

Sl. No Safety Precautions Yes NA

1. Stability of stacked load prior start of loading/lifting

Are all safety devices of the crane such as Over load indicator, Limit switch, Warning lamp
2.
with Horn, Brakes in Good conditions and checked prior crane used for lifting.
3. Lifting area is cordoned off & sign board are displayed
4. Double Tag line are available.
5. Loading /Material handling team explained the job safety and method of handling.
6. After loading, load tied properly and secured against toppling and falling.
7. Adequate, suitable and certified lifting gears available.
8. Ground conditions are well compacted, hard enough for crane placement/Operation
10. Is signalmen and Operator are trained by Crane OEM and authorized for Operation?
11. Is Crane used for lifting activity certified by competent authority prior to use?
12. Operator and Signalmen are trained by crane OEM and given authorized operation certificate.
13. Danger sign at lifting workplace and warning light displayed on projected loads.
14. PPE’s / Safety Gadgets as applicable
Safety Safety Reflective Life Fall Hand Safety
Type Safety Net Goggles
Helmet Shoe Jacket Line arrester Gloves Harness
Tick
Night Work Precautions
14. General area & task Illumination is provided and secured properly
15. Emergency vehicle and driver available at standby
a. Non-compliance observed at work place to be closed prior commence of night work
16.
b. Continues on job supervision to be available for the night works

Any Remark__________________________________________________________________________________

____________________________________________________________________________ (Contractor/PMC)

The below signing person will be responsible to ensure that the above described work will be done under all the safety precautions
mentioned on the permit and job safety analysis as required by the project.

Note: Lifting activities will be permitted only in the day light conditions.
Permit Closing Details
Permit requesting by Contractor Permit approved by-PMC
Sign Sign Sign
Sign Sign Sign Sign
Time Time Time
Time Time Time Time

Site Engineer HSE – S/C Site Engineer PMC - HSE Site Eng. S/C HSE – S/C PMC - HSE

PTWS - LIFTING WORK PERMIT - R1 - 10.03.2017 Page- 1 of 1