Hazardous Waste Permit Form

Section 1: Requisition

Permit No.

Date

Issue Time

Valid Up To

Ship Name

Applicant (Mukadam/Sub-cont)

JHA Report No.

Location / जगह

Work Description

Name of Workers

Section 2 & 3: Permits & Activity

Section 2: Associated Permits

Safe Entry / प्रवेश (जहाज) की अनुमति

Confined space / बंद स्थान की अनुमति

Work at height / ऊंचाई पर काम

Other / अन्य

Section 3: Activity / Type of Waste

Section 4: Work Site Preparation / Precaution

Criteria	Status	Remarks

Section 5 & 6: PPE & Emergency Items

Section 5: Personal Protective Equipment

Section 6: Emergency Items

Approvals & Signatures

Supervisor

Safety (Sec 7)

Plot Mgr

Mukadam (Sec 8)

Close: Mukadam

Close: Safety

Supervisor Name

Safety Officer

Plot Manager

Section 9: Permit Closure

Permit is closed; job is contd. Please issue new permit

Permit is closed; job is completed. Waste safely transferred to designated storage.

Permit is cancelled, as present conditions are not conductive for carrying out the work

Closure Time:

Permit Status:

Issue Hazardous Material Removal Permit