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    Mechanical Work Permit - For Print From 6000-R01

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    NIvedita

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Mechanical Work Permit - For Print From 6000-R01

    Uploaded by

    NIvedita
    11 views2 pages

    Original Title

    Mechanical Work Permit- For print from 6000-R01

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
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    11 views2 pages

    Mechanical Work Permit - For Print From 6000-R01

    Uploaded by

    NIvedita

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Doc No: EHS-ALL-SQE-MLWP-8105; Rev 01

    PTW No TBT No
    Mechanical Lifting Work Permit
    Lifting Plan, No.

    Name of the Project:


    Exact location of Work:

    Working Contractor / Agency:

    Description of Work:

    Permit valid: From (Date & Time) To (Date & Time)

    If extended (Time up to)

    A. Following safety precautions are taken care off.


    S Yes/ No/ NA/ Sr. Mechanical Lifting Safety Yes/ No/ NA/
    Mechanical Lifting Safety Precaution
    N Remarks No Precaution Remarks
    Lifting equipment is inspected as Guide rope is used to control
    1. 7.
    per checklist and OK to use. swinging of load.
    Operator is competent and have Ground compacted, even and
    2. 8.
    valid license. no loose soil surrounding area
    Sweep area of crane free from
    Valid TPI certificate of all tools &
    3. 9. overhead/ surrounding
    tackles
    obstruction
    Lifting plan is available for load
    equal to or more than one ton. For
    Ladder for safe access to the
    4. load less than one ton, lift study / 10.
    work area provided
    load chart to be verified for safe
    lifting.
    No lifting to be performed in adverse
    Medical fitness certificate
    weather and boom to be lowered.
    5. 11. available for working at height
    Extra care for Coastal area to be
    taken as per the statutory requirement
    Working team is trained &
    6. 12. COVID-19 Precaution
    competent
    B. PPEs required during work (Tick mark whichever is required & provided)

    Safety Shoes □ Helmet □ Hi-Viz Jacket □ Goggles□ Gloves□ Double lanyard full body harness □

    Specify any other PPEs required

    C. Is Hazard & Risk Identified during LMRA including Co-laterals, captured in TBT form, and briefed to team. Yes □ No □

    C1. Additional Safety Precautions:

    D. I understand the hazard involved and have taken all necessary precautions for the job
    Permit Authority
    Requested by (Working agency) Issued by (SL authorized person)
    Name

    Signature

    Designation

    Date /Time

    Mobile

    D1. Random Check (at least once per day by - Permit issuer / Site EHS / EHSMiP/ Site Manager/ Project Manager)
    Observation/ Recommendation Name & Signature

    Page 1 of 2
    E. Persons Working under PTW
    S. No. Name Gate pass no S. No. Name Gate pass no
    1 8

    2 9

    3 10

    4 11

    5 12

    6 13

    7 14

    F. Extension of work permit (To be filled only for same day, job & team)
    Permit Extension request by working agency

    Name: Signature: Date: Time:

    Verified & approved by Siemens permit issuer:

    Name: Signature: Date: Time:

    G. Closure/ Return of Permits:


    1. Waste cleared from work site. Yes □ No □
    2. All men & material is removed from site: Yes □ No □
    3. All edge protection places as before: Yes □ No □

    Requester of working agency:

    Name: Signature: Date: Time:

    Verified by Siemens Permit Issuer:

    Name: Signature: Date: Time:

    Note: Lifting plan is mandatory to be prepared if Load to be lifted is equal to or more than one ton.

    Golden Rules for Heavy Lifting Work -

    Life Saving Rules-


    1. Access & control the risk before starting the work.
    2. Maintain safe distance from suspended loads.
    3. For controlling load movement during material shifting, mandatory to use tag line
    4. Use of First-Generation Hydra Crane is Prohibited

    Zero Harm Culture @ Siemens Principles:


    1. Zero incidents – it is achievable!
    2. Health and safety – no compromises!
    3. We take care of each other!

    Applicable Safety Essential:


    1. Maintain a safe distance from any suspend load
    2. Cranes & Lifting

    Page 2 of 2

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