SmartCheck | COMPUTERISED MAINTENANCE MANAGEMENT SYSTEM

Raise WorkPermit

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Permit No^*

Date^*

Contractor^*

Location^*

Description of work

PERSONAL PROTECTIVE EQUIPMENT : TICK THOSE THAT APPLY
PPE-Helmet,Boots,Coverall	Gloves	Goggles	Face Shield
Welfare Facility	Hearing Protection	Safety Harness	Communication means
Dust Mask	Positive breathing apparatus	Electrical Safety Helmet(Arc-rated)	Arc Flash Suit(Full Body)
Safety Shoes	Electrical Insulated Gloves	Face Shield with Arc Protection	Flame-Resistant Clothing
Rubber Mat Insulated Platform for operators	Flame Resistant Clothing
Other precaution/safety equipment required

SERVICES BEING WORKED ON
Electrical	HVAC	Fire	Structural/Civil
Plumbing	Utility Systems	Other (Specify)

	NAME AND DETAILS OF WORK TEAM : TRAINED PERSONNEL FOR TASK EXECUTION
	SNO	Name	Contact Number

Emergency Information

Emergency Contact Number^*

LOCKOUT/TAG:Must be used if any of the following hazards exist
Electrical	Liquid/free-flowing Solids
Excessive heat	Moving Part

PERMIT APPROVAL
Permit valid from	Start date:		End date:
Permit valid from	Start time:	12 hours format	End time:	12 hours format

GENERAL CONDITIONS
General conditions: The Contractor must carry this Permit while accessing the site. The Contractor is responsible for rectifying all damages and losses to the services caused while accessing the requested location. The Contractor staff must have the mentioned mandatory PPEs, Tools, Uniform, and ID Card while accessing the requested location; otherwise, the Safety Officer has the right to stop the work instantly. Upon completion of the work mentioned in this permit, the original copy of this permit must be returned to the HSE Office. All works that have the potential to generate dust or smoke must be informed to the Engineering Team in order to avoid any false alarms. The HSE Team or Contractor must ensure that all workers are wearing PPEs and that appropriate safety practices are in place. The safety of the workers and the site is the responsibility of the Contractor; thus, the Contractor is fully responsible for any injuries, loss of life, or damage to properties due to accidents or incidents. The Engineering Teams and Security Team have the complete authority to stop any works that are found violating the General Conditions or site safety rules. Any accidents, or damage to building assets caused by negligence or violation of company SOPs, shall fall under the Contractor's scope. Compensation for such damages will be borne by the Contractor. I hereby declare that: I have read, understood, and accepted the General Conditions of this Permit-to-Work. I accept full responsibility for undertaking the actions in the area/on the equipment detailed in this Permit-to-Work. No attempt will be made by myself, or by the staff under my control, to carry out actions in any other place or on any other piece of equipment. I take full responsibility for the specific work as mentioned in this permit and accept liability for any damage, loss, or other consequences arising from this work. I further acknowledge that any negligence, violation of company SOPs, or failure to comply with safety standards that result in accidents, damage to assets, injuries, or loss of life will fall under my/our responsibility as Contractor/Competent Person in charge.
Signed being the Competent person in charge of the work.

GENERAL CONDITIONS

General conditions:

The Contractor must carry this Permit while accessing the site.
The Contractor is responsible for rectifying all damages and losses to the services caused while accessing the requested location.
The Contractor staff must have the mentioned mandatory PPEs, Tools, Uniform, and ID Card while accessing the requested location; otherwise, the Safety Officer has the right to stop the work instantly.
Upon completion of the work mentioned in this permit, the original copy of this permit must be returned to the HSE Office.
All works that have the potential to generate dust or smoke must be informed to the Engineering Team in order to avoid any false alarms.
The HSE Team or Contractor must ensure that all workers are wearing PPEs and that appropriate safety practices are in place.
The safety of the workers and the site is the responsibility of the Contractor; thus, the Contractor is fully responsible for any injuries, loss of life, or damage to properties due to accidents or incidents.
The Engineering Teams and Security Team have the complete authority to stop any works that are found violating the General Conditions or site safety rules.
Any accidents, or damage to building assets caused by negligence or violation of company SOPs, shall fall under the Contractor's scope. Compensation for such damages will be borne by the Contractor.

I hereby declare that:

I have read, understood, and accepted the General Conditions of this Permit-to-Work.
I accept full responsibility for undertaking the actions in the area/on the equipment detailed in this Permit-to-Work.
No attempt will be made by myself, or by the staff under my control, to carry out actions in any other place or on any other piece of equipment.
I take full responsibility for the specific work as mentioned in this permit and accept liability for any damage, loss, or other consequences arising from this work.
I further acknowledge that any negligence, violation of company SOPs, or failure to comply with safety standards that result in accidents, damage to assets, injuries, or loss of life will fall under my/our responsibility as Contractor/Competent Person in charge.

Signed being the Competent person in charge of the work.

Date		Time	12 hours format