Annexure - A

VIL HSW: Working at height

This permit is to be issued for any work being carried out 1.8 mtrs above normal floor level.

Site ID INTN006430 Location ICR_DURAIRJAPURM PTW No. ROT/INTN006430/14122018/HT/Shankaravel.d/2527939

Application Date 14/12/2018 Time 14:13:38
Purpose Of Work climbing mast, poles and towers
Valid From(DD/MM/YYYY) 14/12/2018 14:30 Valid upto(DD/MM/YYYY) 14/12/2018 17:30

MWFM ID NA Work Order Number

Measures to be taken by Permit Receiver and Approved by Issuer

No. Consideration Answer(Yes/No) Remarks

1 Is the height worker physically fit to work? Yes
2 In case of beehive/bird nest removals, is the person trained on VIL approved No
module ?
3 Is the area & exclusion zone cordoned off/barricaded to prevent entry of people in Yes
the drop zone?
4 Are scaffold/working platform etc, secured against movement at top &base? Yes
5 Is full body harness with double lanyard worn for W@H & safety helmet/hard hat Yes
with chin strap worn by all workers at site?
6 Are safe anchoring points available for securing the safety harness? Yes
7 Is the work required to be done in hours of darkness? If yes, then following No
conditions must be met:
8 Are all height workers having provision to maintain contact with one other at all Yes
times?
9 Are climbing path & working environment sufficiently illuminated (shadow & glare Yes
free stationary light?
10 In case material lifting is required, is Lift Plan present and attached? Yes
11 In case of work at cell-site, are all people trained on RF-EMF Safety? Yes
12 Is a picture of entire working team wearing required PPE along with supervisor Yes
attached?
13 Is tool box talk conducted to explain scope of work and related hazards/ control Yes
measures to permit receiver?
14 Is the job involving electrical isolation/underground work? If yes, then mention No
relevant permit no.

Endorsement

Name Remark Rejection Remark Company Status Date & Time

1 @ Risk Shankaravel D Ok EVOLVE Approved 14/12/2018 14:17
[ROT/INTN006430/14122018/HT/3841793] TECHNOLOGIES &
SERVICES PVT.LTD

Name Date & Time

Permit Receiver shankaravel.d 14/12/2018 14:13
Permit Issuer alexson.t2 - huawei 14/12/2018 14:17

Permit Receiver (supervisor)

Confirmation Date & Time

Permit Receiver Above activities completed 14/12/2018 16:40
Permit Issuer Checked for completion 14/12/2018 17:08

Declaration
Permit Issuer:Person issuing the work permit to the employee/contractor/1@risk in order to ensure the work is done safely. Permit issuer have issued the permit
based on the feedback from receiver & after risk mitigation.
Permit Receiver:Person receiving permit from issuer. Permit receiver have ensured that risk assessment done correctly for the work, for which the work permit is
given & should carry out the work safely, in the true spirit of safety & not just to fulfill an obligation.

CAUTION
1.If there is a change in responsible persons(1@risk),duration or site condition mentioned in the permit & risk assesment template,the permit case to be validated.
2.In such case existing permit needs to be renewed or extented.
3.In case activity is changed or added, new permit needs be issued.
4.No work to be allowed in case of low visibility

Vodafone Idea Ltd.

 Annexure - A

VIL HSW: Working at height

This permit is to be issued for any work being carried out 1.8 mtrs above normal floor level.

Site ID INTN006430 Location ICR_DURAIRJAPURM PTW No. ROT/INTN006430/14122018/HT/Shankaravel.d/2527939

Application Date 14/12/2018 Time 14:13:38
Purpose Of Work climbing mast, poles and towers
Valid From(DD/MM/YYYY) 14/12/2018 14:30 Valid upto(DD/MM/YYYY) 14/12/2018 17:30

MWFM ID NA Work Order Number

Measures to be taken by Permit Receiver and Approved by Issuer

No. Consideration Answer(Yes/No) Remarks

1 Is the height worker physically fit to work? Yes
2 In case of beehive/bird nest removals, is the person trained on VIL approved No
module ?
3 Is the area & exclusion zone cordoned off/barricaded to prevent entry of people in Yes
the drop zone?
4 Are scaffold/working platform etc, secured against movement at top &base? Yes
5 Is full body harness with double lanyard worn for W@H & safety helmet/hard hat Yes
with chin strap worn by all workers at site?
6 Are safe anchoring points available for securing the safety harness? Yes
7 Is the work required to be done in hours of darkness? If yes, then following No
conditions must be met:
8 Are all height workers having provision to maintain contact with one other at all Yes
times?
9 Are climbing path & working environment sufficiently illuminated (shadow & glare Yes
free stationary light?
10 In case material lifting is required, is Lift Plan present and attached? Yes
11 In case of work at cell-site, are all people trained on RF-EMF Safety? Yes
12 Is a picture of entire working team wearing required PPE along with supervisor Yes
attached?
13 Is tool box talk conducted to explain scope of work and related hazards/ control Yes
measures to permit receiver?
14 Is the job involving electrical isolation/underground work? If yes, then mention No
relevant permit no.

Endorsement

Name Remark Rejection Remark Company Status Date & Time

1 @ Risk S. Ramesh Babu Ok Evolve Technologies Approved 14/12/2018 14:17
[ROT/INTN006430/14122018/HT/3841796] & Services PVT. LTD.

Name Date & Time

Permit Receiver shankaravel.d 14/12/2018 14:13
Permit Issuer alexson.t2 - huawei 14/12/2018 14:17

Permit Receiver (supervisor)

Confirmation Date & Time

Permit Receiver Above activities completed 14/12/2018 16:40
Permit Issuer Checked for completion 14/12/2018 17:08

Declaration
Permit Issuer:Person issuing the work permit to the employee/contractor/1@risk in order to ensure the work is done safely. Permit issuer have issued the permit
based on the feedback from receiver & after risk mitigation.
Permit Receiver:Person receiving permit from issuer. Permit receiver have ensured that risk assessment done correctly for the work, for which the work permit is
given & should carry out the work safely, in the true spirit of safety & not just to fulfill an obligation.

CAUTION
1.If there is a change in responsible persons(1@risk),duration or site condition mentioned in the permit & risk assesment template,the permit case to be validated.
2.In such case existing permit needs to be renewed or extented.
3.In case activity is changed or added, new permit needs be issued.
4.No work to be allowed in case of low visibility

Vodafone Idea Ltd.

 Annexure - B

Risk Assessment Template - Application For PTW @ Height

Site No & Name : INTN006430 & Date & Time : 14/12/2018 14:13:38 Reason of Work : climbing mast, poles and towers
ICR_DURAIRJAPURM

Assessed By : shankaravel.d & Verified By : PTW No : Issued To : Shankaravel D,S. Ramesh Babu
alexson.t2 ROT/INTN006430/14122018/HT/Shankaravel.d/252
7939

No. Risks involved Risk Remarks

Present(Ye
s/No)
1 Unsafe access /egress to the work area No
2 Slip & trip hazards or falling objects No
3 Unprotected edges within 2 metres No
4 Improper access ladder or unprotected stairway No
5 Structural damages to foundations or tower No
6 Unavailability of proper work platforms /tower members No
7 Presence of animals, bees hives, bird nests, etc. No
8 Overhead High Tension lines in close proximity to access path / work area No
9 Presence of protruding structures including trees and branches No
10 Extreme weather conditions like thunderstorms, strong winds, dust storm, heat No
waves, snowfalls
11 Insufficient lighting /poor visibility No
12 Exposure to moving traffic (vehicle/ pedestrian) No
13 Any other risk not identified above (Mention in remark) No

Risk Mitigation Action Plan

The Risk Mitigation plan should be based on severity of any possible injury and the other on the likelihood of harms occurring

No Risk Identified..!

Note:-It is ensured that all risks identified are mitigated and reduced as low as possible by appropriate action before executing the Work at Height.
Vodafone Idea Ltd.