ALANGHSE SERVICES PERMIT

ALANGHSE SERVICES

WORK AT HEIGHT PERMIT

ALANGHSE-WAH-03
REV. 01
Controlled Form

SECTION 1: REQUISITION PERMIT IDENTIFICATION
Applicant (Mukadam)	VISHAL PANDEY	Ship Name	VISHAL PANDEY
Location / जगह	[ WAH_LOC_DESC ]
Work Description	[ WAH_DESC ]
Workers / Attendant	VISHAL PANDEY / [ WAH_ATTENDANT ]
Date / Issue Time	2026-08-10 / 08:00 AM	Valid up to / Permit No.	[ WAH_VALID ] / [ WAH_PERMIT_NO ] A/B
JHA Report No.	[ WAH_JHA ]

SECTION 2: ASSOCIATED PERMITS
☑ Confined space permit	☑ Cold work permit	☑ Hot work permit	☑ Safe for entry

SECTION 3: WORK SITE PREPARATION / PRECAUTION

WORK AREA & ENVIRONMENT

EQUIPMENT & INFRASTRUCTURE

PEOPLE, PPE & AUTHORIZATION CONTROLS

Yes

Gas Monitoring Required?
गैस की निगरानी आवश्यक?

Yes

Is there confined space areas?
क्या वह जगह “बंद जगह है?

Yes

Is ventilation to the area adequate?
क्या कटिंग की जगह में हवा का आगमन सही है?

Yes

Are lighting & access adequate?
क्या कटिंग की जगह में रौशनी सही है?

Yes

Emergency escape route is marked?
आपातकालीन भागने का मार्ग चिह्नित है?

Yes

Availability of ladder in good condition?
अच्छी स्थिति में सीढ़ी की उपलब्धता?

Yes

Are ladder, safety harness and fall arrestor inspected and tagged?
सीढ़ी, सुरक्षा हार्नेस और फ़ॉल अरेस्टर का निरीक्षण?

Yes

Are tools secured by lanyard/bag/belt?
उपकरण डोरी/बैग/बेल्ट से सुरक्षित हैं?

Yes

Safety harness and fall arrestor attached to strong anchor point?
मजबूत एंकर पॉइंट से जुड़े होते हैं?

Yes

Pre-job Meeting done
काम के पहले मीटिंग हुआ

Yes

Barricade and proper signage displayed?
बैरिकेड्स और उचित साइनेज प्रदर्शित?

Yes

Person available at standby
स्टैंडबाय पर उपलब्ध व्यक्ति

Yes

Worker in proper PPE
उचित पीपीई में कार्यकर्ता

Yes

Trained worker?
प्रशिक्षित मज़दूर?

SECTION 4: PPE		SECTION 5: EMERGENCY ITEMS
☑ Safety Helmet	☑ Safety Goggles	☑ S.C.B.A set	☑ E.E.B.D	☑ First Aid Box
☑ Safety Shoes	☑ Cotton gloves	☑ Safety Harness	☑ Tripod	☑ Fire Hose Standby
☑ Ear plug	☑ Coveralls	☑ Fire Extinguisher	☑ Fire pump ready	☑ Fall Arrestor
☑ Dust mask	☑ Life Jacket	☑ Sand buckets	☑ Stretcher	☑ Fire Blanket

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 7: MANDATORY WORK RULES

1. 100% Tie-off is mandatory. Always hook lanyard to a rigid structure, never to the scaffolding pipe you are standing on.
2. Do not throw materials or tools from height. Ensure drop-zones are barricaded below.
3. Halt work immediately in case of heavy rain, lightning, or high wind.
4. Work at height is to be stopped, when wind speed is ≥ 35 km/hr. (ref: HSE, UK).
5. This permit is strictly required for any work at or above 1.8 Meters.

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

SECTION 8: 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

THIS PERMIT IS VALID FOR MAXIMUM 08 HOURS ONLY, INCLUDING REST HOURS. THIS PERMIT WILL BE ISSUED DEPENDING ON THE WEATHER FORECAST.

FORMAT PREPARED BY: HSE MANAGER APPROVED BY: GENERAL MANAGER