ALANGHSE SERVICES
REV. 01
Controlled Form
ALANGHSE SERVICES |
WORK AT HEIGHT PERMIT | ALANGHSE-WAH-03 REV. 01 Controlled Form |
| STEP 1: REQUISITION PERMIT IDENTIFICATION | |||
| 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 |
| STEP 2: ASSOCIATED PERMITS | |||
☑ Confined space permit |
☑ Cold work permit |
☑ Hot work permit |
☑ Safe for entry |
| STEP 3: PRE-WORK SAFETY VERIFICATION | |||||||
| CRITERIA | Y | N | N/A | CRITERIA | Y | N | N/A |
| 1. Pre-job Meeting done | ☑ |
8. Are ladder, safety harness and fall arrestor inspected and tagged? | ☑ |
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| 2. Gas Monitoring Required | ☑ |
9. Emergency escape route is marked & unobstructed? | ☑ |
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| 3. Is there confined space areas? | ☑ |
10. Are all tools, secured by lanyard/bag/belt? | ☑ |
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| 4. Is ventilation to the area adequate? | ☑ |
11. Safety harness and fall arrestor attached to strong anchor point? | ☑ |
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| 5. Are lighting & access to the work area adequate? | ☑ |
12. Person available at standby | ☑ |
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| 6. Barricade and proper signage displayed? | ☑ |
13. Worker in proper PPE | ☑ |
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| 7. Availability of ladder in good condition? | ☑ |
14. Trained worker? | ☑ |
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| STEP 4: PPE / 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 |
☑ Dust mask |
☑ Life Jacket |
☑ Sand buckets |
☑ Stretcher |
☑ Fire Blanket |
| STEP 5: JOINT INSPECTION / AUTHORISATION | ||
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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 6: SPECIAL INSTRUCTIONS / MUKADAM ACKNOWLEDGEMENT | |
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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. Mukadam acknowledgement: I have read, understood and explained these instructions to all workers. Signature: _____________________ Date: 2026-08-10 |
| STEP 7: 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 |