ANNEXURE – 2
Work Clearance From ______ Hrs.of date _________ To ______ Hrs. of Date _________ (Valid
for the shift Unless specified)
Issued to (Department / Section / Contractor) _________________________________________
Work order No. ___________________ Exact Location of work (Area / Unit / Equipment No. etc.)
_____________________________________________________________________________
_____________________________________________________________________________
Description of work _____________________________________________________________
___________________
Name of Permittee __________________________ Date ___________ [Signature of Permittee]
FOLLOWING ITEMS SHALL BE CHECKED BEFORE ISSUING THE PERMIT