HEALTH, SAFETY & ENVIRONMENTAL (HSE)
LIFTING PERMIT
Form ID: NBHH-HSE-FM-002 Rev. No: 00
Date: 21-06-2024
AL HUDAYRIAT ISLAND PDA INFRASTRUCTURE - INFRA 3A & 3B ABU DHABI
JOINT SITE INSPECTION IS REQUIRED WHEN ISSUING A PERMIT
Location:
Permit No:
1. APPLICATION AND WORK DESCRIPTION BY SITE ENGINEER
I have checked the work site and the information is in this Permit and supplementary attachment. I am satisfied that the information is adequate and correct.
The completed Lifting Plan, MS and RA must be attached to this permit for the lift to proceed.
After completion of job Return the signed, completed permit to Triconstruct HSE Department.
Area:
Name:
Company:
Department:
Exact Work Location:
Time
duration:
Tel. No#
Signature:
Date:
From:
To:
From:
To:
2. Work Description
3. Type of Lifting
Appointed Person
AP. Lic. Validity
AP. TPC Validity
Lifting Supervisor
LS TPC validity
Remarks
Operator
Op. Lic. Validity
Op. TPC Validity
Rigger Name
Rigger TPC validity
Remarks
4. LIFTING TEAM
5. PERMIT RECEIVER CHECKLIST
Crane Inspection Check List
Overhead Power Lines
Access / Egress
Adjacent Operations
Fall, Slip, Trip Hazards
Lifting operation over
road/highway/public
Barricade the lift area
Competent Crane Operator
Common Lifting
Complex / Critical Lifting
Confined Space / Vessel entry
Exclusion Zone Around
Lifting premises
Outriggers Extension Acceptable
Lifting Hazard Signs
Safe Working Load’ (SWL)?
Verify Load Capacity
Competent / Sufficient Riggers
Outrigger Pads Provided
Full supervision
TPC of crane and lifting gears
Tagline provided
Safe Distance from Excavation
Others:
Communication System
6. SPECIAL NOTES / REMARKS
7. LIFTING PLAN (Lifting Plan shall be prepared by Lifting Appointed Person)
Lifting Plan No.
Prepared By:
I hereby accept to implement the above mentioned lifting plan to perform the task described in section 02.
Name:
8. PERMIT ISSUING AUTHORITY
Date:
Sign:
I have examined the Permit for work described.
Name:
Date:
9. TYPE OF LIFTING
EQUIPMENT
Type
Sign:
Reg No.
Reg Expiry Dt.
TPC Expiry Dt.
Insurance Expiry Dt.
Remarks
10. LIFTING GEARS (Lifting Supervisor to fill & sign this part)
S.No
01
Type
Lifting equip ID
TPC Certificate No.
TPC Expiry Date
Remarks
02
03
04
05
06
07
08
09
10
I have inspected above mentioned all lifting equipment and can use for this permit implementation only.
Name:
Date:
11. REVALIDATION FOR COMMON LIFTING OPERATION (6 DAYS)
DATE
SAT
SUN
Sign:
MON
TUE
WED
THU
Site Chief/Engineer
Lifting Supervisor
12. IS THE WORK SITE INSPECTED AFTER COMPLETION OF JOB TO ENSURE SAFE AND CLEAR
13. WORK COMPLETION / CLOSEOUT
14. PERMIT COMPLETION / CLOSE OUT
LIFTING SUPERVISOR:
YES
NO
EMERGENCY CONTACTS
HSE/PTW COORDINATOR:
Appointed Person:
SIGNATURE:
SIGNATURE:
Project Emergency
Hot Line
DATE:
DATE:
Construction Manager
FRI