TATA Consulting Engineers Ltd

Contractor name: Permit number:

GENERAL WORK PERMIT

Area: _________________________________________ _ Date: ___/___/____ Time: ______ _ __
(Area description must be precise – Attach Drawing & Job Safety Analysis)
Name of Site Engineer (Permit Requesting Authority): _________________________ Sign: _________ __
Name of Safety Officer:______________________________ Sign: ________ __
Name of Work Performing contractor: __________________ __ ____
Name of Cont. Site In charge: ______________ ___________ Contact Number:____________ ____
Description of work: _______________________ _____________________________________ __
_________________________________________ ___________________________________ _ __
Work Execution Date: ___________ __ Time Valid From: ____________ To: _____________ ___
The above signing person will be responsible to ensure that the above described work will be done under all
the safety precaution mentioned on the PTW and required by the Project.

The following precautions are to be taken

Not
No Item Yes
Required
1 Proper Access/ Exit available.
2 Proper & Safe scaffolding, platform, ladder provided
3 Daily housekeeping of the work area completed
Identification & protection of any utility services like electric cables, pipes etc. nearby before
4
start of work.
5 Checked safe condition of hand tools/ Power tools.
6 Plant, Vehicles safe worthiness checked.
7 Excavated material kept away from excavated edge. Or removed from location.
8 Vehicle access provided, Flag man at location.
Personal Protective Equipment provided. Minimum applicable are safety helmet, safety
9
goggles, safety shoes, Hand gloves, dust mask, Etc.
10 Solid & strong barricade provided around excavation/work area
11 Safety Sign board are in place.
12 Warning Tape during night provided around excavation.
13 Others
14
15

Reviewed & Approved By TCE (Permit Issuing Authority):

TCE Safety Engineer : _____________ __ Sign: __________ Date: __ ___Time ___ _ __
TCE Site Engineer: _____________ ___ Sign: __________ Date: __ ___Time ___ _ __

I understand the precaution to be taken as described above and as per Project requirement & here by
confirm that Work will be executed under my supervision by following all precaution & Safety Rules.

Name of Work Performing Authority: __ __________Sign: __________ Date: __ __Time___ __

Permit Cancellation:
I hereby declare that the work is completed/ suspended, all workers under my control have been withdrawn
and the site restored to a safe tidy condition.

Name of Work Performing Authority : __ __________Sign: __________ Date: __ __Time___ __

Name of Site Engineer : __ __________Sign: __________ Date: __ _ _Time___ __
(Permit Requesting Authority)
Name of TCE Engineer : __ __________Sign: __________ Date: __ _ _Time___ __
(Permit Issuing Authority)
(This Permit is valid only for the date it is issued)