This document is an excavation and civil work permit that specifies the details of an excavation job, including: - The applicant department and contractor - The exact location of the excavation - The specified job and excavation depth - Commencing and completion times - Signatures from electrical and civil approving authorities confirming the area is safe to excavate - Precautions that must be taken, such as barriers and illumination - Potential hazards identified in the area like gas lines - Required protective equipment It provides important instructions that the permit must be displayed, is only valid for the specified area and time, and must be reissued if work extends beyond the expiry time. Additions or alterations invalidate

1. Excavation and Civil Work Permit
Sr. No. ________________
Applied by: ________________ Department / Contractor: _____________________
Area ______________________ Exact Location: _____________________________
Specified Job: ____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Excavation depth: __________________________
Commencing time: ____________ hrs. Date: _______________
Completion time: _____________ hrs. Date: _______________
Sign of applying Authority: __________________
Electrical Approving Authority-
Area of excavation contain
High Voltage Cable Low Voltage Cables
Medium Voltage Cable No Cables
Any other Cable: _______________________________________________________________________________
Signed by Name: __________________ NO.: ___________________
Time: ___________________ Date : _______________________
Civil Approving Authority
Area of Excavation contains.
API Sewerage line Sanitary Waste Sewerage line
Road Cutting Manholes
Oil Sewers Other: _______________________
Catch Basin ______________________________
Signed by Civil Engineer : ___________________ Name : ____________________ NO.: ________________
Time : __________________ Date : ____________________
Precaution to be taken by performing Authority.
.
Floor Area Wet Supervision by Elect. Deptt.
Road barriers required Illumination required
Area Cordoned Any other: _______________________
Hazard Identified.
Fire Water Line Drinking Water Line Service Water Line Furnace Oil Line
F. O / HSD Line White Product Line Gas Line Any Other : ______________________
Protective Equipment / Clothings, Required.
Gloves Safety Belt Eye Protection Dust Mask Safety Harness
Safety Shoes Coverall Safety Helmet Any Other ________________________
Gas test of the area made by: _______________________________ Explosively: _______________________________
No: ______________ Signature _______________
Maint - II ______________ Engg: ___________________ Concerned area _______________
No: ______________ No: ______________ No: ______________
Date : ____________ Time ________ Date : ____________ Time __________ Date : ____________ Time _________
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2. Important Instructions:
1. This permit shall be displayed at a conspicuous place close to area under
excavation / construction.
2. This permit is valid for the specified area only.
3. This permit is valid for the specified time and duration mentioned on it.
4. It shall be reissued / extended if the job has to be done beyond expiry time.
5. Permit can be extended only once.
6. Addition / Alteration on the permit except renewal makes the permit invalid.
7. Excavation is any work, which requires breaking the earth surface, or pavement
including the removal of previously installed roadways, slabs or foundation at or
below the surrounding ground level.
8. On any excavation job Electrical Deptt. Supervision is must.

3. CONFINED SPACE ENTRY PERMIT
PERMIT NO. ___________
Specification of work
Department ______________________
• Equipment Identification No _______________________________________________________________
• Exact work location ______________________________________________________________________
• Work to be performed :_____________________________________________________________________
__________________________________________________________________________________________
Equipment Status:
Depressurized Drained Ventilated Free from toxic material
Isolated Cooled Oxygen Sufficient
Free from flammable Material Blinded Machines & devices inside isolated and tagged
Area clean and safe Any other
Precautions to be taken by Receiving / Issuing Authority:
Use Gloves Use Fresh air line required Use Safety Harness Use Eye Protection
Use Face Shield Use Canister Mask Use Self Contained B.A set
Use Rubber Boots Use Dust Mask Use Hearing Protection Attendant Deputed
Extra light 24 Volt required Any other _________________________________________________________
Gas Test:
Gas test to be carried out:
Date Time Oxygen %LEL H2S Safe for Entry
(Yes/No
Signature HSE / Fire
Protection
Permit Begins at ___________ hrs. Date ________________ Expiresat _____________ hrs. Date ___________________
I have inspected the above mentioned Confined Space and declare that it is a safe entry.
Issuing Authority:
Signed by Issuing Authority ____________________
Name: _________________________Employee # ___________ Date: _____________ Time: ________________
Receiving Authority:
Signed by Receiving Authority ____________________
Name: _________________________Employee # ___________ Date: _____________ Time: ________________
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Please read precautions and important points at the back.

4. Confined Space Entry General Instruction
1. Fresh air line apparatus be used continuously in confined space if oxygen is less than 19.5%.
2. Fresh air line / air compressor must be positioned well upwind away from the job
3. Life line and Safety harness must be worn by each man working inside vessel / confined space
where necessary.
4. Attendant must observe man working inside all the time.
5. Attendant must not leave the site unattended and if necessary call the man working inside to
leave the confined space till his return to the site.
6. Attendant must be standby with fresh air line / SCBA. (When required)
7. Flame Torches must be removed outside from confined space when not in use.
Important
• This permit be displayed conspicuously on or near the job.
• Adequate ventilat ion must be provided. (When required)
• Addition / Alteration makes the permit invalid
• Safety equipment needed for work must be used properly as instructed and returned
back after job.
• All signatures on permit must include Employee #. ______________
• Any draining operation from adjacent equipment should be avoided.

5. HOT WORK PERMIT
PERMIT NO. ___________
NAKED FLAME / SPARK POTENTIAL
1. Specification of work Department
______________________
• Identification of equipment ___________________
• Exact work location _________________________
• Work to be performed:_______________________________________________________________________
__________________________________________________________________________________________
2. Equipment to be used:
Electric Welding Machine Mobile Crane Compressor Sand/ Grit blasting
Mobile pump Motor Vehicle Temp. Lights Electric/Pneumatic Drills
Gas cutting set Grinding Hot tapping Powered steel wire
brushes
IC Engine/ Liqua blaster Welding Generator Electric Extension/ Board Hacksaw Cutting
Compacter / Vibrator Other
______________________________________________________________
Signed by initiator: / Receiving Authority _________________________ Date: __________________
3. Hazards Identified by Issuing authority:
Liquid/ Gas under pressure Hot Material/Surface Moving Machinery Toxic Material
Confined Space entry Flammable Material Lifting Operation Danger of Falling
Work at height Electrically deenergized Other ________________________________
4. Precautions to be taken by issuing Authority:
Thoroughly Ventilated Suitable Access/ Egress Consider Adjacent work
API Sewer Covered Isolated Drains/Sewers sealed within 10 meters
Safety watch provided Blinded Fire Extinguisher on site
Work area kept water wet Fire hose or Turret Nozzle Pressured & Tested
Area free of flammable / combustible materials Follow precautions at the back of the permit
Other _____________________________________________________________________________________
5. Precaution to be taken by Receiving Authority
Equipment Correctly Positioned Earthling connection provided
Other if any ____________________________________________________
6. Protective clothing and Safety Equipment:
Gloves Supplied Air Breathing Apparatus Safety Harness Eye Protection
Safety Belt Face Shield Canister Mask S.C.B.A set
Full Chemical Suit Dust Mask Hearing Protection Fall Arrest Equipment
Other
_______________________________________________________________________________________
7. Supplementary Permit:
Excavation Permit Scaffolding Permit Confined space entry Permit
El Electrical Energize/De-energize Permit________________________ Others _______________________
8. Periodical Site Gas Test:(Mandatory/Not Applicable) ( To be mentioned by issuing Authority)
8 – a. If Yes. (Mention time duration) ________________________
8 – b. Explosivty Result.___________ Name _____________ # __________ Signed __________
• Permit begins at _____________ hrs. Date: ______________________
• Permit expires at _____________ hrs Date: ______________________
9.Issuing Authority:
I have inspected the Equipment/work location and declare that the work specified on this permit can now be performed
safely
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6. General Instructions:
1. The permit serves purely the safety of personal and Equipment, based on such, the person filling
this permit is to ensure that all requirements and precautions are taken either mentioned in the permit
or not.
2. Within hazardous areas, no hot work is allowed to be carried out by Maint, Inspection or other
Service Departments, without the knowledge and permission of Operation Manager.
3. The issuing / Receiving authority is entirely responsible to ensure that the site is safe for carrying
out the job from the moment he signs or receives the permit until the moment of the cancellation. He
should stop work immediately when the condition changes to unsafe and he can then issue a new
permit.
4. Tick (✓) against any action only after ensuring it is done properly and completely. If there is any
doubt of job completion, this should be marked in the permit with the necessary precautions required.
5. The initiator of this permit should be supervisor or above.
6. Cancellation of the permit is to be done on the Hard copy on site under intimation to concerned
deptt. By issuing / receiving authorities.
7. Fire equipment needed for the work must be used properly as instructed, they should be returned
back to Fire Deppt after completion of work, in a good and clean condition by the performing crew or
be returned to their original location. If there is any damage or change in condition of the safety
equipment, it should be immediately reported to Fire Protection Deptt.
8. Site supervisor has the right to stop the work at any time if he feels that it is unsafe to continue. He
should then inform his supervisor.
9. Hot work should be stopped immediately during any emergency conditions within or in the
vicinity units.
10. Hot work should be stopped immediately during high air velocity which may create a hazardous
situations of blowing welding / cutting, grinding slag and sparks to the vicinity units.
11. All hydrocarbon-draining operations within the vicinity units should be stopped during the hot
work.
12. All signing authorities must include their employment numbers on the permit.
13. When opening or disconnecting equipment which may release hazardous materials irrespective of
all action taken, they must be taken care of accordingly.
14. If the work is started during a shift other than when the permit was issued, the site supervisor
should be informed before performing the job.
15. Permit shall stand cancelled if not started within 45 minutes of the issuance time.
16. Issuing authority shall ensure use of proper safety equipment.
17. Equipment used for the Hot Work jobs: will be switched off / de-energized when work site is
unattended.
Hot Work PermitHot Work Permit

7. PERMIT NO. ___________
RADIOGRAPHY PERMIT
Source Strength ____________________________________________ Curie
Work To Be Performed _________________________________________________
______________________________________________________________________
Exact Location
____________________________________________________________________
Performing Deptt./ Contractor
_______________________________________________
Precautions To Be Taken By Performing Authority: Yes
• Is Area Cordoned Off?
• Is Area Man Freed?
• Are Radiography Sign Boards Placed?
• Is fire watch required?
• Is adequate warning, lamp or audible signal on site provided?
• Is Fire Station/ Security Informed?
• Names of Roads Blocked if any
____________________________________________________
• Others:
__________________________________________________________________
Permit must be displayed on Job Site.
Permit Begins at ___________ hrs Date _______________
Issuing and Receiving Authorities to read the instructions at the back page of the hard copy
Received By Issued By
Signature _______________ Signature __________________
Name: _____________________________# ___________ Name: _____________ # ___________
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8. Important Instructions:
1 This permit does not authorize any work other than actually carrying out the radiography. If any
work is to be done for preparation or for assisting the radiography, the respective Hot / Cold /
Electrical / Vessel Entry Permit must be obtained
5 It shall be extended / reissued if the radiography has to be continued beyond expiry time.
6 If the work is not started or is stopped for any period due to safety consideration, the permit
must be revalidated by the issuing authority before the work is started or resumed.
2 This permit shall be displayed at a conspicuous place close to the work area.
3 This permit is valid for the specified location only.
4 This permit is valid only upto the specified time.
7 This permit can be extended only once.
8 Addition / alteration on the permit except renewal makes the permit invalid.
RADIO GRAPHY WORK PERMIT