ALANGHSE SERVICES PERMIT

ALANGHSE SERVICES

HAZARDOUS WASTE PERMIT

ALANGHSE-F-08
REV. 01
Controlled Form

SECTION 1: REQUISITION PERMIT IDENTIFICATION
Applicant (Mukadam)	VISHAL PANDEY	Ship Name	VISHAL PANDEY
Location / Work Description	[ HZ_LOCATION ] - [ HZ_DESC ]
Date / Issue Time	2026-08-10 / 08:00 AM	Valid up to / Permit No.	08:00 AM / [ HZ_PERMIT_NO ] A/B
Name of Workers	VISHAL PANDEY	JHA Report No.	[ HZ_JHA_NO ]

SECTION 2: ASSOCIATED PERMITS
☑ Safe for Entry (Vessel)	☑ Confined space permit	☑ Work at height permit	☑ Other: [ HZ_AP_OTHER ]

SECTION 3: ACTIVITY
☑ ACM Removal	☑ POPs (Solid/ Liquid PCB, PBB, PBDE, PFOS, HBCDD, PCN, SCCP) removal
☑ Heavy Metals (Cadmium, Hexavalent, chromium, Lead, Mercury and compounds)			☑ Lead containing paint chips
☑ Lead Acid Battery	☑ Paint /Chemical Box	☑ Sacrificial Anode	☑ Ballast water sediments
☑ Bilge/oily water removal	☑ Waste oil/Sludge waste	☑ Solid-Liquid ODS	☑ Others: [ HZ_ACT_OTHER ]

SECTION 4: WORK SITE PREPARATION / PRECAUTION

WORK AREA & ENVIRONMENT

EQUIPMENT & INFRASTRUCTURE

PEOPLE, PPE & AUTHORIZATION CONTROLS

Yes

Gas Monitoring Required?

Yes

Are there confined space areas?

Yes

Are lighting & access adequate?

Yes

Any hot work permission nearby?

Yes

Emergency escape route is clean?

Yes

Area isolated from the other workers?

Yes

All hazardous materials are Labelled?

Yes

Barricade and proper signage displayed?

Yes

HDPE Packing bag and tape Available?

Yes

Leak proof plastic container/tray available?

Yes

Lead lined wooden box available?

Yes

Trolley available?

Yes

Is crane available to transport waste to yard?

Yes

Pre-job Meeting done?

Yes

IHM Available (Captain’s/3RD Party/PCHM)?

Yes

Equipment and PPE of 3rd party cross checked?

Workers medically fit for hazmat handling?

SECTION 5: PPE					SECTION 6: EMERGENCY ITEMS
☑ Safety Helmet	☑ Filter mask	☑ Latex gloves	☑ Harness	☑ Gumboot	☑ SCBA set	☑ Fire Hose	☑ Stretcher	☑ Eye Wash
☑ Disp Suits	☑ Ear plug	☑ Goggles	☑ Chem suits	☑ Shoes	☑ EEBD	☑ Gel Blanket	☑ Fire Blanket	☑ Tripod
☑ Coveralls	☑ Cotton gloves	☑ Dust mask	☑ Chem Goggle	☑ Other	☑ First Aid Box	☑ Fire pump	☑ Fire suit	☑ HDPE bags
					☑ Safety Harness	☑ Spill kit	☑ Mercury kit	☑ Oil Booms
					☑ Extinguisher	☑ Sand bucket	☑ Rope	☑ Torch

SECTION 7: AUTHORISATION CARD
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 PANDEY Designation: Ship / Yard Supervisor Signature:	APPROVAL BY HSE DEPARTMENT I am satisfied with safety precautions and hereby give permission to commence work. Name: VISHAL PANDEY Designation: Safety Officer / HSE Manager Signature:	PERMIT CONTROLLER / PM-GM Approval by Plot Manager (PM) / General Manager (GM). Name: VISHAL PANDEY Designation: PM/GM Signature:

SECTION 8: MANDATORY WORK RULES

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

Mukadam acknowledgement: I have read, understood and explained these instructions to all workers.
Signature: _____________________ Date: 2026-08-10

SECTION 9: PERMIT RETURN (PLEASE TICK WHERE APPLICABLE)
✓/X	STATUS	PERSON	NAME	SIGNATURE	TIME
☑	Permit is closed, job is completed	Mukadam	VISHAL PANDEY		08:00 AM
☑	Permit is closed, job is completed	Safety Officer	VISHAL PANDEY		08:00 AM

SECTION 10: EMERGENCY CONTACT NUMBERS
SL. NO.	DESIGNATION	NAME	CONTACT NO.
1	HSE MANAGER	ROCKY SINGH	7990404108
2	PLOT MANAGER	PRAVIN SHIYAL	79846 07070