INDIAN OIL CORPORATION LIMITED

MANMAD TERMINAL
(This Permit is valid only for the date it is issued)
EXCAVATION WORKPERMIT
Area of work Date: / / Time

Name of Site Engineer (Permit Req u es t i ng Authority) Sign:

Name of work performing contractor:
Name of Cont. Site I n charge: Sign: Date:
Description of work:

Work Execution Date: Time Valid From: To:

The above signing person will be responsible to ensure that the above described work will be done under all
the safety precaution mentioned on the PTW and required by the Project.

The following precautions are to be taken

NO The following points should be taken care off Y N/A
.
1 Proper Access/ Exit available at work area.
2 Exits – No slip, Trip, Fall Hazards due to compressed air hose, cable, etc.
3 Proper & Safe scaffolding, platform, ladder provided.
4 Daily housekeeping of the work area completed
on Priority basis.
5 Identification & protection of any utility services like electric cables, pipes etc.
before start of work
6 Checked safe condition of hand tools/ Power tools.
7 Plant, Vehicles safe worthiness checked.
8 Excavated material kept away from excavated edge. or removed from location.
9 Vehicle access provided. Flag man Provided at work location.
10 Personal Protective Equipment provided. Minimum applicable are
safety helmet, safety goggles, safety shoes Hand gloves, dust mask
etc.
11 Soft & Hard barricade provided around excavation area with safety signage’s
boards.
12 Safety Sign board are at work location.
13 Warning Tape / flash light during night provided around excavation.
14 If excavated more than 1.5 Meter depth Confined space entry precaution in
place
Name of Contractor S a f e t y Officer: Sign: - Time:
Name of Contractor Site I n charge: Sign: Time:

Reviewed & Approved by Site Engineer (Permit Issuing Authority):

Name: Sign: Date: Time:
Name of safety in-charge: Sign: - Date: Time:
I understand the precaution to be taken as described above and as per Project requirement & here by confirm that Work
will be executed under my supervision by following all precaution & Safety Rules.
Permit Closing and incase extend of the permit.