Draft PTW Format

JIMAH EAST POWER
2 X 1000 MW COAL FIRED POWER PLANT

PROJECT
PERMIT TO WORK
A. Applicant ( to be completed by Non-MRC / Contractor)
Permit No.:
General
Confined Space
Critical Lifts
Hot Work
Excavation
Electrical
Working at height
Location
Requesting Company
Date
Requested by :
Manpower
Type of Tools
(Person in Charge)
Required
Machinery
Tick
Electrical
Work Activity
Hand Tools
B. Precaution to be taken prior to commencement and during the work

Safety Precaution
Yes
Safety Precaution
N/A
Appropriate PPE
Signages
Fall Protection
10
Adequate ventilation
Fire Extinguisher
11
Gas Monitoring
Fire Blanket to Arrest Spark / Flame
12
Breathing Apparatus
Pipeline Purged
13
Adequate Lighting
Access / Egress
14
Underground Utilities Identified
Shoring
15
Job Safety Analysis
16
Other (if any)
7
8
Guardrails / Barricades
Other Safety Precaution required please specify
Yes
N/A
C. Permit Issuer ( to be completed by Working Partners / MRC )

Permission is given for the work to proceed subject to the conditions specified above
Type of Work/Permit
From Date:
Time:
Site Manager
General ( 7 days)
To
Time:
HSSE Manager
Critical ( 12 hours )
Date:
Tick
Permit Validity 7 days ( to be renewed daily by Working Partners / MRC )
Day / Date
Approved by Site Manager / HSSE Manager
D. Performing Authority Acceptance ( to be completed by Non-MRC / Contractor )

I certify that I have read and understand this permit and that the work will be carried out in accordance with the requirements.
Name
Signed
Signature
Date
Time
Company
(Responsible
Person)
Transfer of Responsible Person

E. Completion of Work ( to be completed by Non-MRC / Contractor )
I hereby declare that all work for which this permit was issued has been completed, all personnel under my control have been withdrawn and the work area and all associated equipment has
been left in safe condition.
Name
Signature
Date
Time
Company
Signed
F. Cancellation ( to be completed by Working Partners / MRC )
This permit is cancelled.
Name
Signed
Original
; Permit Applicant
2nd copy
; Permit Issuer
Signature
Date
Time
Company
3rd copy
; C-HSSE Dept.
4th copy
; C-HSSE Dept. upon PTW Issuance
JIMAH EAST POWER

2 X 1000 MW COAL FIRED POWER PLANT
PROJECT
PERMIT TO WORK
A. Applicant ( to be completed by Non-MRC / Contractor)
Permit No.: PTW-HSL-001
General
Confined Space
Critical Lifts
Hot Work
Excavation
Electrical
Working at height
Location
refer to attached drawing
Requested by :
Requesting Company
R.Sathish Kumar
(Person in Charge)
HSL
Date
Manpower
Type of Tools
Required
Machinery
18.04.2016
Tick
Electrical
Work Activity
Hand Tools
B. Precaution to be taken prior to commencement and during the work

Safety Precaution
Yes
Safety Precaution
N/A
Appropriate PPE
Signages
Fall Protection
10
Adequate ventilation
Fire Extinguisher
11
Gas Monitoring
Fire Blanket to Arrest Spark / Flame
12
Breathing Apparatus
Pipeline Purged
13
Adequate Lighting
Access / Egress
14
Underground Utilities Identified
Shoring
15
Job Safety Analysis
16
Other (if any)
Guardrails / Barricades
Other Safety Precaution required please specify
Yes
N/A
C. Permit Issuer ( to be completed by Working Partners / MRC )

Type of Work/Permit
From Date:
Time:
Site Manager
General ( 7 days)
To
Time:
HSSE Manager
Critical ( 12 hours )
Date:
Tick
Permit Validity 7 days ( to be renewed daily by Working Partners / MRC )
Day / Date
Approved by Site Manager / HSSE Manager
D. Performing Authority Acceptance ( to be completed by Non-MRC / Contractor )

I certify that I have read and understand this permit and that the work will be carried out in accordance with the requirements.
Name
Signed
(Responsible
Person)
Signature
Date
Time
Company
HHC
Transfer of Responsible Person

E. Completion of Work ( to be completed by Non-MRC / Contractor )
I hereby declare that all work for which this permit was issued has been completed, all personnel under my control have been withdrawn and the work area and all associated equipment has
been left in safe condition.
Name
Signature
Date
Time
Company
Signed
F. Cancellation ( to be completed by Working Partners / MRC )
This permit is cancelled.
Name
Signed
Original
; Permit Applicant
2nd copy
; Permit Issuer
3rd copy
; C-HSSE Dept.
4th copy
; C-HSSE Dept. upon PTW Issuance
Signature
Date
Time
Company

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JIMAH EAST POWER

2 X 1000 MW COAL FIRED POWER PLANT

B. Precaution to be taken prior to commencement and during the work

Fire Blanket to Arrest Spark / Flame

Underground Utilities Identified

Job Safety Analysis

Other (if any)

C. Permit Issuer ( to be completed by Working Partners / MRC )

Approved by Site Manager / HSSE Manager

D. Performing Authority Acceptance ( to be completed by Non-MRC / Contractor )

Transfer of Responsible Person

; C-HSSE Dept. upon PTW Issuance

JIMAH EAST POWER

Permit No.: PTW-HSL-001

refer to attached drawing

B. Precaution to be taken prior to commencement and during the work

Fire Blanket to Arrest Spark / Flame

Underground Utilities Identified

Job Safety Analysis

Other (if any)

C. Permit Issuer ( to be completed by Working Partners / MRC )

Approved by Site Manager / HSSE Manager

D. Performing Authority Acceptance ( to be completed by Non-MRC / Contractor )

Transfer of Responsible Person

; C-HSSE Dept. upon PTW Issuance

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