Bhanu Dyes Pvt. LTD.: Cold Work Permit

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BHANU DYES PVT. LTD.

COLD WORK PERMIT


Sr. No.

Occupier Name & Address: M/s. Bhanu Dyes Pvt.Ltd. Plot No. 758/B, GIDC Jhagadia-393110
Work clearance from Date: Time: Hrs.to Hrs.
Issued to (Department/ Section/ contractor):
Exact Location of work (Area/ Unit/ Equipment No. etc.)
Nearest Fire Hydrant Point/ MCP:
Description of work:
Sign. of Permittee:

** THE FOLLOWING ITEM SHALL BE CHECKED BEFORE ISSUING THE PERMIT.


(Tick mark in the appropriate box by receiver)
1. Equipment / Work Area inspected, checked, cleaned and covered

2. Equipment properly steamed / purged, water flushed

3. Equipment blibded/disconnected / closed / isolated / wedge opened

4. Equipment properly drained and depressurized

5.Equipment electrically isolated and tagged vide

6. Proper ventilation and lighting provided

7. Area cordoned off & caution boards / tags provided.

8. Gas test (HC/ Toxic etc) done: HCs= %LEL Toxic gas= PPM
Remarks:

1. The activity has the following expected residual residual hazards (Tick the relevant items):
O Lack of Oxygen O Toxic Gases O Pyrophoric Iron O Corrosive Chemicals
O NOx/ SOx Gas O Combustible gases O Steam Condensate O Other, if specify

Following additional PPE to be used in addition to standards PPE


(Helmet, Safety Shoes, Hand gloves, Boiler suit)
(Tick the relevant items):
O Face Shield O Dust Respirator O Lifeline O Compressed Air Set
O Goggles O Fresh Air Mask O Safety Harness O Earmuff
Name & Signature of: Safety officer (SO)/ Issuer

Permittee/ (receiver)

Clearance Renewal: (Permit No.: )


DATE FROM UP TO TIME RECEIVER ISSUER REMARKS,IF
EXTENDED UP ANY
TO

General Instructions:
1. The work permit shall be filled up carefully and accurately in clear handwriting in clear handwriting ensuring that
complete information is provided in all the sections / subsections and none of column is left blank.
2. Appropriate safe guards and required personnel protective equipment (PPEs) shall be determined prior to
starting the work.
3. Requirement of standby personnel from process / Maintenance / Contractor / Fire & Safety etc until the end of job.
4. In case of emergency, all work must be stopped and all nonessential personnel must gather at Assembly points.
5. For renewal of work clearance, the issuer shall ensure that the conditions are satisfactory for the work to contiuue.
If the conditions have changed, if may be necessary to issue a new permit or amend the existing permit.
6. This permit shall be valid for a period of 8 hours only, unless it is renewed/ extended. This clearance on the same
permit can be renew / extended up to a maximum of seven calendar days.
7. Original permit must be available at work site at all time.
8. On completion of the work, the permit shall be closed and returned to the issuer.
9. The permit shall be issued in duplicate.original permit (white) for receiver/ executer and duplicate (Pink) shall be
retained by issuer.
10. Tool-box talk has to be ensured by receiver before start of work and record for the same shall be maintained.

Closing of the work permit:


** Receiver: Certified that the subject work has been completed / stopped and area cleared
Sign.:
** Issuer: Verified that the job has been completed and area cleared and is safe from any hazard.
Sign.:

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