ALANGHSE SERVICES
REV. 01
Controlled Form
ALANGHSE SERVICES |
HAZARDOUS WASTE PERMIT | ALANGHSE-F-08 REV. 01 Controlled Form |
| SECTION 1: REQUISITION | |||
| Date: | 2026-08-10 | Issue Time: | 08:00 AM |
| Valid up to: | 08:00 AM | Permit No. - A / B | [ HZ_PERMIT_NO ] |
| Applicant Name (Mukadam): - | VISHAL PANDEY | Ship Name: - | VISHAL PANDEY |
| Location / जगह | [ HZ_LOCATION ] | JHA Report No. (If any) | [ HZ_JHA_NO ] |
| Work Description / काम का विवरण | [ HZ_DESC ] | ||
| Name of Workers / कार्यकर्ताओं के नाम | VISHAL PANDEY | ||
| SECTION 2: ASSOCIATED PERMITS | |||
☑ Safe for Entry Permit (Vessel) |
☑ Confined space permit |
☑ Work at height permit |
☑ Other: [ HZ_AP_OTHER ] |
| SECTION 3: ACTIVITY | |||
☑ ACM Removal- एसीएम निष्कासन |
☑ POPs (Solid/ Liquid PCB, PBB, PBDE, PFOS, HBCDD, PCN, SCCP) removal- पीओपीस निष्कासन |
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☑ Heavy Metals (Cadmium, Hexavalent, chromium, Lead, Mercury and their compounds) removal |
☑ Lead containing paint chips removal |
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☑ Lead Acid Battery Removal |
☑ Paint /Chemical Box Removal |
☑ Sacrificial Anode Removal |
☑ Ballast water sediments Removal |
☑ Bilge water/oily water removal |
☑ Waste oil/Sludge waste removal |
☑ Solid-Liquid ODS Removal |
☑ Others: [ HZ_ACT_OTHER ] |
| SECTION 4: WORK SITE PREPARATION / PRECAUTION SPLIT CHECKLIST | |||||||
| CRITERIA | Y | N | N/A | CRITERIA | Y | N | N/A |
1. Pre-job Meeting done / काम के पहले मीटिंग हुआ |
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9. Barricade and proper signage displayed? बैरिकेड्स और उचित साइनेज प्रदर्शित? |
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2. Gas Monitoring Required / गैस की निगरानी आवश्यक |
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10. Area isolated from the other workers? अन्य श्रमिकों से अलग किया हुआ क्षेत्र? |
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3. Are there confined space areas? क्या वह जगह “बंद जगह है |
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11. Equipment and PPE of the third party/workers are cross checked? |
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4. All hazardous materials are Labelled / सभी खतरनाक सामग्रियों को लेबल किया गया है |
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12. HDPE Packing bag and tape Available? एचडीपीई पैकिंग बेग और टेप उपलब्ध हैं |
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5. Are lighting & access to the work area adequate? |
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13. Leak proof plastic container/tray available? लीक प्रूफ प्लास्टिक कंटेनर / ट्रे उपलब्ध हैं |
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6. Any hot work permission nearby waste removal area? |
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14. Lead lined wooden box available- लकड़ी का बक्सा उपलब्ध है |
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7. IHM Available (Captain’s Declaration/3RD Party/PCHM) |
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15. Trolley available- ट्रॉली उपलब्ध है |
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8. Emergency escape route is clean? क्या आपातकालीन रास्ता साफ़ है |
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16. Is crane available to transport waste from ship to the yard? |
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| SECTION 5: PERSONAL PROTECTIVE EQUIPMENT (PLEASE TICK WHERE APPLICABLE) | ||||
☑ Safety Helmet/हैलमेट |
☑ Disposable Suits |
☑ Coveralls/ड्रेस |
☑ Filter mask/फ़िल्टर मास्क |
☑ Ear plug/ ईयर प्लग |
☑ Cotton gloves/सूती मोजा |
☑ Latex/Nitrile gloves |
☑ Safety Goggles/ सेफ्टी चसमा |
☑ Dust mask/ धूल मुखौटा |
☑ Safety Harness |
☑ Chemical suits |
☑ Chemical safety goggles |
☑ Gumboot /गंबूट |
☑ Safety Shoes |
☑ Others / अन्य |
| SECTION 6: EMERGENCY ITEMS (PLEASE TICK WHERE APPLICABLE) | ||||
☑ S.C.B.A set/ एससीबीए सेट |
☑ E.E.B.D/आपातकालीन श्वास |
☑ First Aid Box |
☑ Safety Harness |
☑ Fire Extinguisher |
☑ Fire Hose Standby |
☑ Wet Gel Blanket |
☑ Fire pump ready |
☑ Oil /chemical spill kit |
☑ Sand bucket |
☑ Stretcher/स्ट्रेचर |
☑ Fire Blanket / अग्नि कंबल |
☑ Fire suit/फायर सूट |
☑ Mercury spill kit |
☑ Rope/ रस्सी |
☑ Portable Eye Wash |
☑ Tripod with harness |
☑ Spare HDPE bags |
☑ Spare Oil Booms |
☑ Torch light/ टॉर्च |
| SECTION 7: JOINT INSPECTION - APPROVAL SEQUENCE | ||
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A. PERMIT APPLICANT
I am satisfied that all precaution has been taken and all safety arrangements will be maintained for entire duration of work.
Name: VISHAL PANDEYDesignation: Ship Supervisor / Yard Supervisor Signature |
B. HSE APPROVAL
I am satisfied with safety precautions and hereby give permission to commence work.
Name: VISHAL PANDEYDesignation: Safety Officer / HSE Manager Signature |
C. PERMIT CONTROLLER / PM-GM
Approval by Plot Manager (PM) / General Manager (GM). Name: VISHAL PANDEY Designation: PM/GM Signature |
| SECTION 8: SPECIAL INSTRUCTION/कुछ जरुरी सुचना जो मूकादम को परमिट लेने से पहले जानकारी लेना जरुरी हैI |
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1. नियर मिस कभी भी छुपाने की कोसिस न करे, उसे फौरन सेफ्टी ऑफिसर/HSE प्रबंधकको रिपोर्ट करे 2. काम समाप्त होने के तुरंत बाद परमिट सेफ्टीऑफ़िसर/HSE प्रबंधक को लौटा दे! 3. परमिट मे जिस स्थान और जहाज की परमिट दी गयी है उसके अलावा किसी अन्य जगह पर काम न करे मैं VISHAL PANDEY ऊपर दिए गये सभी निर्देसो को सही से पढ़ और समझ लिया हैतथाकाम में लगे सभी कार्यकर्ताओं को भी समझाया गया है पूरी काम समाप्त होने तक इस ऊपर लिखे निर्देसो का सही से पालन करूँगा | मूकादम का हस्ताक्षर: _________________________ दिनांक: 2026-08-10 |
| SECTION 9: PERMIT RETURN ((PLEASE TICK WHERE APPLICABLE) | |||||
| ✓/X | STATUS | PERSON | NAME | SIGNATURE | TIME |
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Permit is closed, job is contd. Please issue new permit | Mukadam | VISHAL PANDEY | 08:00 AM | |
| Safety Officer | VISHAL PANDEY | ||||
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Permit is closed, job is completed | Mukadam | VISHAL PANDEY | ||
| Safety Officer | VISHAL PANDEY | ||||
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Permit is cancelled, as present conditions are not conductive for carrying out the work | ||||
| SECTION 10: EMERGENCY CONTACT NUMBERS | |||
| SL. NO. | NAME | DESIGNATION | CONTACT NO. |
| 1 | ROCKY SINGH | HSE MANAGER | 7990404108 |
| 2 | PRAVIN SHIYAL | PLOT MANAGER | 79846 07070 |