ALANGHSE SERVICES
REV. 01
Controlled Form
ALANGHSE SERVICES |
HAZARDOUS WASTE PERMIT | ALANGHSE-F-08 REV. 01 Controlled Form |
| SECTION 1: REQUISITION / CONTROL INFORMATION | |||
| 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: PERMITS | SECTION 3: HAZARDOUS ACTIVITY CLASSIFICATION | ||
|
☑ Safe for Entry (Vessel)☑ Confined space permit☑ Work at height permit☑ Other: [ HZ_AP_OTHER ]
|
☑ 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 |
|
☑ Bilge/oily water removal |
☑ Waste oil/Sludge waste |
☑ Others: [ HZ_ACT_OTHER ] |
|
| SECTION 4: COMPLIANCE MATRIX | ||||
| CHECK / CRITERIA | YES | NO | N/A | REMARKS |
| ENVIRONMENT & WASTE PREPARATION | ||||
| 1. Gas Monitoring Required? | ☑ |
[ Q2_RMK ] | ||
| 2. Are there confined space areas? | ☑ |
[ Q3_RMK ] | ||
| 3. Are lighting & access to the work area adequate? | ☑ |
[ Q5_RMK ] | ||
| 4. Any hot work permission nearby waste removal area? | ☑ |
[ Q6_RMK ] | ||
| 5. Emergency escape route is clean? | ☑ |
[ Q8_RMK ] | ||
| 6. Area isolated from the other workers? | ☑ |
[ Q10_RMK ] | ||
| HAZARDOUS MATERIALS & EQUIPMENT | ||||
| 7. All hazardous materials are Labelled? | ☑ |
[ Q4_RMK ] | ||
| 8. HDPE Packing bag and tape Available? | ☑ |
[ Q12_RMK ] | ||
| 9. Leak proof plastic container/tray available? | ☑ |
[ Q13_RMK ] | ||
| 10. Lead lined wooden box available? | ☑ |
[ Q14_RMK ] | ||
| 11. Trolley available? | ☑ |
[ Q15_RMK ] | ||
| 12. Is crane available to transport waste from ship to the yard? | ☑ |
[ Q16_RMK ] | ||
| PERSONNEL & AUTHORIZATION | ||||
| 13. Pre-job Meeting done? | ☑ |
[ Q1_RMK ] | ||
| 14. IHM Available (Captain’s Declaration/3RD Party/PCHM)? | ☑ |
[ Q7_RMK ] | ||
| 15. Barricade and proper signage displayed? | ☑ |
[ Q9_RMK ] | ||
| 16. Equipment and PPE of the third party/workers cross checked? | ☑ |
[ Q11_RMK ] | ||
| SECTION 5: PPE + SECTION 6: EMERGENCY READINESS | ||||
☑ SCBA set |
☑ EEBD |
☑ First Aid Box |
☑ Safety Helmet |
☑ Filter mask |
☑ Latex gloves |
☑ Harness |
☑ Gumboot |
☑ Fire Hose |
☑ Stretcher |
☑ Eye Wash |
☑ Disp Suits |
☑ Ear plug |
☑ Goggles |
☑ Chem suits |
☑ Gel Blanket |
☑ Fire Blanket |
☑ Tripod |
☑ Coveralls |
☑ Cotton gloves |
☑ Dust mask |
☑ Fire pump |
☑ Fire suit |
☑ HDPE bags |
☑ Spill kit |
| SECTION 7: JOINT INSPECTION & AUTHORISATION MATRIX | ||
| A. PERMIT APPLICANT | B. HSE APPROVAL | C. PERMIT CONTROLLER / PM-GM |
|
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: |
I am satisfied with safety precautions and hereby give permission to commence work.
Name: VISHAL PANDEY
Designation: Safety Officer / HSE Manager Signature: |
Approval by Plot Manager (PM) / General Manager (GM).
Name: VISHAL PANDEY
Designation: PM/GM Signature: |
| SECTION 8: SPECIAL INSTRUCTIONS / ACKNOWLEDGEMENT |
|
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
I have read and understood all instructions above and have explained them to all workers engaged in the work.
Mukadam Signature: _____________________ Date: 2026-08-10 |
| SECTION 9: PERMIT RETURN | |||||
| ✓/X | STATUS | PERSON | NAME | SIGNATURE | TIME |
☑ |
Permit is closed, job is completed | Mukadam | VISHAL PANDEY | 08:00 AM | |
| Safety Officer | VISHAL PANDEY | ||||
| SECTION 10: EMERGENCY CONTACT NUMBERS | |||
| SL. NO. | DESIGNATION | NAME | CONTACT NO. |
| 1 | HSE MANAGER | ROCKY SINGH | 7990404108 |
| 2 | PLOT MANAGER | PRAVIN SHIYAL | 79846 07070 |