Permit to work - Blasting

Project Name :
Company requesting the Permit :
Section A: Information
Location of blasting :
Duration of blasting : Start time :
Name of the Licenced Blaster/Shot Fierier:
Number of helpers deployed for :
A copy of this permit is to be kept with the Activity / supervisor in charge at all
Section B: The following control measures have been implemented (if applicable)
Prior to starting of Blasting
Si.No Descreption Yes No N/A Descre
1 Whether the detonators are checked individually for 12 Are electronic items /radio
continuity and resistance prohibited in the location?

13 Whether all the excessive

2 Do all the detonators belong to the same manufacturer from work spot
Whether proper signaling system is established to Whether it has been coun
3 prevent trespassers entering the blasting zone, siren or 14 persons involved in the op
hooter is available. the spot after loading?

Whether the environment

4 Whether the explosives and cartridges are of approved 15 considered?
quality (Rain/Sunny/Wind/Thunde

16 Whether the bore holes ar

5 Whether the condition of lead/leg wires are checked? debris before explosives ar

6 Whether sockets in the blasted area are flushed with air 17 Whether suitable warning
& water and plugged site?

7 Whether the explosives and cartridges selected for use 18 Whether blaster’s shelter
are of correct size condition?
19 Whether a record has bee
8 Whether no of entry points identified and access control
is established register indicating
a) Date & Time of blast :__
b) Number of holes charge
9 Whether the danger zone is suitably cordoned and c) Type of explosive used:
flagmen posted at important points d) Amount of charge per h
e) Firing pattern & sequen
10 Whether all the drillers have been provided with ear
plugs, helmets. goggles and gumboots?
 Record
11 a) Quantity of explosive brought from magazine 20 Any Electrical /Telecom lin
b) Quantity of explosive used If so, specify the distance &
c) Quantity of explosive returned to magazine
Check points after blasting:

1 Whether any mis‐fire detected, If yes Give the no. of 2 Whether’ ALL CLEAR’ siren
holes___________ Brief of action taken: time of ‘ALL CLEAR’ siren.T
Section C: Permit Requesation and Approvals
i) Permit Requested By:
I hereby declare that work by myself and/or my person(s) under my charge in the above blasting shall be carried out in acc
permit
Name : Signature :
ii) Permit Issued By :
I have verified the Method Statement & Risk Assessment and it is suitable. All necessary safety precautions in relation to th
taken.
Name : Signature
iii) Section E: Permit Authorised By
I am confident that all necessary safety precautions in relation to the hazards identified with this task have been take
Client representative / Engineer in Charge
Name Signature
PERMIT CLOSE
Section D:
i) Permit Requestor Requested for closing
I hereby declare that all persons under my charge have been withdrawn and warned that it is no longer safe to work or stay in
other equipment have been removed
Name (Same as in section C) Signature
ii) Permit Issuer – Accepted the Closing Request:
I have verified the same as stated in section D(i).
Name (Same as in section C (ii)). Signature
iii) Permit Authorised By – Acknowledge the Closing Request
Client representative / Engineer in Charge
Name (Same as in section C(iii)). Signature
To be returned to the EHS Coordinator after the completion of the work.
 ting
Date :
Pemit No:

End time :
Contact Number :

upervisor in charge at all times

During excavations
Descreption Yes No N/A
re electronic items /radios/mobile phones/pagers
rohibited in the location?
Whether all the excessive cartridges are removed
om work spot
Whether it has been counted that the number of
ersons involved in the operation have come out of
he spot after loading?

Whether the environmental conditions are

onsidered?
ain/Sunny/Wind/Thunders/Lightning)
Whether the bore holes are cleared of all the
ebris before explosives are inserted
Whether suitable warning boards are displayed at
te?
Whether blaster’s shelter is available in good
ondition?
Whether a record has been maintained in separate
gister indicating
Date & Time of blast :_________________
Number of holes charged : ____________
Type of explosive used: _______________
Amount of charge per hole: ____________
Firing pattern & sequence:_____________
 ny Electrical /Telecom line or Cables near by?
so, specify the distance & Voltage ______

Whether’ ALL CLEAR’ siren is blown &mention the

me of ‘ALL CLEAR’ siren.Time: _________

hall be carried out in accordance with the conditions set out in this works

Date

ecautions in relation to the hazards identified in the assessment have been

Date

his task have been taken.

Date

er safe to work or stay in the above blasting and that all materials, tools and

Date/Time

Date/Time

Date/Time
completion of the work.