ALANGHSE SERVICES
ऊंचाई पर कार्य परमिट
REV. 01
Controlled Form
|
ALANGHSE SERVICES |
WORK AT HEIGHT PERMIT ऊंचाई पर कार्य परमिट |
ALANGHSE-F-03 REV. 01 Controlled Form |
| SECTION 1: REQUISITION / मांग | |||
| Date / दिनांक | 2026-08-10 | Issue Time / जारी समय | 08:00 AM |
| Valid up to / मान्य समय | 08:00 AM | Permit No. A/B | [ WAH_PERMIT_NO ] |
| Ship Name / जहाज का नाम | VISHAL PANDEY | Location / जगह | [ WAH_LOCATION ] |
| Applicant (Mukadam) | VISHAL PANDEY | JHA Report No. | [ WAH_JHA ] |
| Work Description / काम का विवरण | [ WAH_DESC ] | ||
| Name of Workers / कार्यकर्ताओं के नाम | VISHAL PANDEY | ||
| Name of Attendant / अटेंडेंट का नाम | [ WAH_ATTENDANT ] | ||
| SECTION 2: ASSOCIATED PERMITS | |||
|
☑
Confined space permit
No. [ LINKED_CONFINED_SPACE ] बंद स्थान की परमिट |
☑
Cold work permit
No. [ LINKED_COLD_WORK ] कोल्ड वर्क परमिट |
☑
Hot work permit
No. [ LINKED_HOT_WORK ] हॉट वर्क परमिट |
☑
Safe for entry
No. [ LINKED_SAFE_ENTRY ] प्रवेश के लिए सुरक्षित |
| SECTION 3: WORK SITE PREPARATION / PRECAUTION |
| ITEMS CHECK | YES | NO | N/A | REMARKS |
| Pre-job Meeting done / काम के पहले मीटिंग हुआ | ☑ |
[ Q1_RMK ] | ||
| Gas Monitoring Required / गैस की निगरानी आवश्यक? | ☑ |
[ Q2_RMK ] | ||
| Is there confined space areas? क्या वह जगह "बंद जगह" है? | ☑ |
[ Q3_RMK ] | ||
| Is ventilation to the area adequate? / क्या हवा का आगमन सही है? | ☑ |
[ Q4_RMK ] | ||
| Are lighting & access to the work area adequate? / क्या रौशनी सही है? | ☑ |
[ Q5_RMK ] | ||
| Barricade and proper signage displayed? बैरिकेड्स और उचित साइनेज प्रदर्शित? | ☑ |
[ Q6_RMK ] | ||
| Availability of ladder in good condition? अच्छी स्थिति में सीढ़ी की उपलब्धता? | ☑ |
[ Q7_RMK ] | ||
| Are ladder, safety harness and fall arrestor inspected and tagged? | ☑ |
[ Q8_RMK ] | ||
| Emergency escape route is marked & unobstructed? | ☑ |
[ Q9_RMK ] | ||
| Are all tools used at height secured by lanyard/bag/belt? | ☑ |
[ Q10_RMK ] | ||
| Safety harness and fall arrestor attached to strong anchor point? | ☑ |
[ Q11_RMK ] | ||
| Person available at standby / स्टैंडबाय पर उपलब्ध व्यक्ति | ☑ |
[ Q12_RMK ] | ||
| Worker in proper PPE / उचित पीपीई में कार्यकर्ता | ☑ |
[ Q13_RMK ] | ||
| Trained worker / प्रशिक्षित मज़दूर? | ☑ |
[ Q14_RMK ] |
| SECTION 4: EMERGENCY ITEMS (PLEASE TICK WHERE APPLICABLE) | ||||
☑ S.C.B.A set |
☑ E.E.B.D |
☑ First Aid Box |
☑ Safety Harness |
☑ Tripod |
☑ Fire Hose Standby |
☑ Fire Extinguisher |
☑ Fire pump ready |
☑ Fall Arrestor/lifeline |
☑ Sand buckets |
☑ Stretcher |
☑ Fire Blanket |
☑ Fire suit |
☑ Rope |
☑ Other: ☑ |
| JOINT INSPECTION / APPROVALS | ||
|
PERMIT APPLICANT Name: VISHAL PANDEY Signature |
HSE DEPARTMENT Name: VISHAL PANDEY Signature |
PERMIT CONTROLLER (PM/GM) Name: VISHAL PANDEY Signature |
| SECTION 6: PERMIT RETURN (PLEASE TICK WHERE APPLICABLE) |
| ✓/X | STATUS | PERSON | NAME | SIGNATURE | TIME | NOTE |
☑ |
Permit is closed, job is contd. Please issue new permit |
Mukadam | VISHAL PANDEY | 08:00 AM | Note: Work at height is to be stopped, when wind speed is ≥ 35 km/hr. (ref: HSE, UK) | |
| Safety Officer | VISHAL PANDEY | |||||
☑ |
Permit is closed, job is completed | Mukadam | VISHAL PANDEY | |||
| Safety Officer | VISHAL PANDEY | |||||
☑ |
Permit is cancelled, as present conditions are not conducive for carrying out the work | |||||
|
REMARKS:
Closure: [ CLOSURE_REMARKS ]
Cancellation: [ CANCELLATION_REASON ] |
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