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Date of Work
Location of work
Duration of work
Description of work
Name of Supervisor (Sub-Contractor)
Name of Safety Supervisor (Sub-Contractor)
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
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?
Date & Time
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