General Work Permit - For Print From No. 7000

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Doc No: EHS-ALL-SQE-GEWP-8106

General Work Permit PTW No____________ TBT 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.
SN Requirements Yes / No / NA / Remarks
A Site Preparation
1. Working team is trained & competent
2. Workmen physically fit to perform the task
3. Segregation & safe stacking of material
4. Housekeeping at workplaces is ensured
5. Availability of safe access & egress to / from workplaces.
6. Availability of work specific PPEs and its right usage
7. Visual inspection of hand tools, power tools and safe to use
8. Availability of adequate illumination
9. Covid 19 requirements fulfilled
B Use of Construction Power
1. Safe routing of construction power cable is ensured.
2. Construction power routed through 30 mA RCCB / ELCB
3. Adequate earthing of tools/equipment is ensured
4. Availability of industrial plugs & socket.
5. DB/ Extension board are placed at safe location to avoid falling in excavated area/ water
C Manual Material Handling Safety Precautions
1. Weight of material is not exceeding 50 kg for male adult & 30 kg for female adult.
2. Obstructions free passage is available.
3. Availability of MSDS & training to team for handling and storage of chemical.
D Plant & Machinery
1. Plant & machinery are inspected as per checklist and safe to use.
2. Cleaner/helper is guiding the driver while reversing the vehicle.
3. Material loaded in construction vehicle is safe & secured
E Manual Excavation (Less than 1.5-meter depth)
1. Excavation area is clearly marked as per drawing.
2. Underground utilities are identified and safe distance / zone is marked for excavation
3. Excavated Soil to be kept at least 1.0 meter away from edge of excavation.
Display of caution /warning board near excavated area and barricaded at public
4.
movement area
F Safety Precautions for Any Other Activity
Details of Any other miscellaneous activity (other than as listed above)
_______________________________________________________
Other Safety Precautions to be taken-
H
1. ______________________________________________
2. ______________________________________________

B. PPEs required during work (Tick mark whichever is required & provided)
Safety Shoes Helmet Hi-Viz Jacket Goggles Gloves Mask 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

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

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
Requester of working agency:
Name: _______________________________________Signature: _______________________________Date: ____________Time: ____________

Verified by Siemens Permit Issuer:

Name: __________________________________Signature: ___________________________Date: __________Time: _________


Key Points to Watch out

Life Saving Rules-


1. Access & control the risk before starting the work.
Zero Harm Culture @ Siemens Principles:
1. Zero incidents – it is achievable!
2. Health and safety – no compromises!
3. We take care of each other!

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