image

Date of Work

Location of work

Duration of work

Manpower

Description of work

Name of Supervisor (Sub-Contractor)

Riggers

Name of Safety Supervisor (Sub-Contractor)

Signalmen

Is the any lifting activities involving crane?

LM no. of crane (s) Particulars of crane involved

If so, name of lifting personnel involved

Name of operator (s) Particulars of crane involved

Lifting Supervisor(s)

Is there a valid lifting permit?if not attacth with this.

Is there any hot works involved?

Is there any use of Explosive powered tools

If so, Are there fire Extinguishers provided?

If so, name of the authorized EPT operator

Is there sufficient lighting provided at the work area?

name

Signature

designation

Date & Time