ALANGHSE SERVICES
REV. 01
Controlled Form
ALANGHSE SERVICES |
WORK AT HEIGHT PERMIT | ALANGHSE-WAH-03 REV. 01 Controlled Form |
| SECTION 1: REQUISITION / CONTROL INFORMATION | |||
| Applicant (Mukadam) | VISHAL PANDEY | Ship Name | VISHAL PANDEY |
| Location / Work Description | [ WAH_LOC_DESC ] - [ 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 |
| SECTION 2: COMPLIANCE MATRIX | ||||
| CHECK / CRITERIA | YES | NO | N/A | REMARKS |
| ENVIRONMENT & PREPARATION | ||||
| 1. Pre-job Meeting done | ☑ |
[ Q1_RMK ] | ||
| 2. Gas Monitoring Required | ☑ |
[ Q2_RMK ] | ||
| 3. Is there confined space areas? | ☑ |
[ Q3_RMK ] | ||
| 4. Is ventilation to the area adequate? | ☑ |
[ Q4_RMK ] | ||
| 5. Are lighting & access to the work area adequate? | ☑ |
[ Q5_RMK ] | ||
| 6. Barricade and proper signage displayed? | ☑ |
[ Q6_RMK ] | ||
| 7. Emergency escape route is marked & unobstructed? | ☑ |
[ Q9_RMK ] | ||
| FALL PROTECTION & EQUIPMENT | ||||
| 8. Availability of ladder in good condition? | ☑ |
[ Q7_RMK ] | ||
| 9. Are ladder, safety harness and fall arrestor inspected and tagged? | ☑ |
[ Q8_RMK ] | ||
| 10. Are all tools, secured by lanyard/bag/belt? | ☑ |
[ Q10_RMK ] | ||
| 11. Safety harness and fall arrestor attached to strong anchor point? | ☑ |
[ Q11_RMK ] | ||
| PERSONNEL & SUPERVISION | ||||
| 12. Person available at standby | ☑ |
[ Q12_RMK ] | ||
| 13. Worker in proper PPE | ☑ |
[ Q13_RMK ] | ||
| 14. Trained worker? | ☑ |
[ Q14_RMK ] | ||
| SECTION 3: PPE + SECTION 4: EMERGENCY READINESS | ||||
☑ S.C.B.A set |
☑ E.E.B.D |
☑ First Aid Box |
☑ Safety Helmet |
☑ Safety Goggles |
☑ Safety Shoes |
☑ Cotton gloves |
☑ Safety Harness |
☑ Tripod |
☑ Fire Hose Standby |
☑ Ear plug |
☑ Coveralls |
☑ Fire Extinguisher |
☑ Fire pump ready |
☑ Fall Arrestor |
| 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 5: SPECIAL INSTRUCTIONS / ACKNOWLEDGEMENT |
|
1. 100% Tie-off is mandatory. Always hook lanyard to a rigid structure, never to 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).
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 6: 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 |