ALANGHSE SERVICES
REV. 01
Controlled Form
ALANGHSE SERVICES |
HAZARDOUS WASTE PERMIT | ALANGHSE-F-08 REV. 01 Controlled Form |
| STEP 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 ] |
| STEP 2: PERMITS | STEP 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 |
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☑ Heavy Metals (Cadmium, Hexavalent, chromium, Lead, Mercury and compounds) |
☑ Lead containing paint chips |
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☑ Lead Acid Battery |
☑ Paint /Chemical Box |
☑ Sacrificial Anode |
|
☑ Bilge/oily water removal |
☑ Waste oil/Sludge waste |
☑ Others: [ HZ_ACT_OTHER ] |
|
| STEP 4: PRE-WORK SAFETY VERIFICATION | |||||||
| CRITERIA | Y | N | N/A | CRITERIA | Y | N | N/A |
| 1. Pre-job Meeting done? | ☑ |
9. Barricade and proper signage displayed? | ☑ |
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| 2. Gas Monitoring Required? | ☑ |
10. Area isolated from the other workers? | ☑ |
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| 3. Are there confined space areas? | ☑ |
11. Equipment and PPE of the third party/workers cross checked? | ☑ |
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| 4. All hazardous materials are Labelled? | ☑ |
12. HDPE Packing bag and tape Available? | ☑ |
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| 5. Are lighting & access to the work area adequate? | ☑ |
13. Leak proof plastic container/tray available? | ☑ |
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| 6. Any hot work permission nearby waste removal area? | ☑ |
14. Lead lined wooden box available? | ☑ |
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| 7. IHM Available (Captain’s Declaration/3RD Party/PCHM)? | ☑ |
15. Trolley available? | ☑ |
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| 8. Emergency escape route is clean? | ☑ |
16. Is crane available to transport waste from ship to yard? | ☑ |
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| STEP 5: PPE / EMERGENCY READINESS | |||
☑ Safety Helmet |
☑ Filter mask |
☑ SCBA set |
☑ Fire Hose |
☑ Latex gloves |
☑ Harness |
☑ Stretcher |
☑ Eye Wash |
☑ Gumboot |
☑ Disp Suits |
☑ EEBD |
☑ Gel Blanket |
☑ Ear plug |
☑ Goggles |
☑ Fire Blanket |
☑ Tripod |
☑ Chem suits |
☑ Shoes |
☑ First Aid Box |
☑ Fire pump |
☑ Coveralls |
☑ Cotton gloves |
☑ Fire suit |
☑ HDPE bags |
☑ Dust mask |
☑ Chem Goggle |
☑ Spill kit |
☑ Mercury kit |
☑ Other |
☑ Safety Harness |
☑ Oil Booms |
☑ Extinguisher |
☑ Sand bucket |
☑ Rope |
☑ Torch |
|
| STEP 5: JOINT INSPECTION / AUTHORISATION | ||
|
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: |
| STEP 7: SPECIAL INSTRUCTIONS / MUKADAM 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 Mukadam acknowledgement: I have read, understood and explained these instructions to all workers. Signature: _____________________ Date: 2026-08-10 |
| STEP 8: 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 |