THDC INDIA LIMITED (2*660MW)

PERMIT TO WORK-COLD WORK PTW NO:- No.:SSL/CW

Unit No:- Date:-

1 Specification of Work Mark All Boxes Yes ,No or N/A(Not Applicable) Valid for 8 hours-After This permit Renewal Required
Date of Application Applicant /Performing Authority Name Department
Location of Work Equipment Name Tag no.

Description of work
Name of Persons Working

Tools & Equipments

2 Hazards Identified
Confined Space Tripping Hazard Excavation Collapse Toxic Gas Fumes Heavy Lifts Hazardous Substances

High pressure jet Pressurised Pipework Unguarded Opening Fall from Height Steam Pressurised Hose Failure
Slipping Hazards Ackward Access Flammable Material Hydrocarbon Area Noise Chemical Hazard

Inadequate Lighting Dropped Objects Radioactive Source Static Electricity Vibration Drowning

Simultaneous Opn Lone worker Electrocution High Voltage Other Hazards

3 Controls in Place
A Initial Gas Testing Oxygen Content Check Continuous Gas Test Fire /Safety Watcher Portable Fire Extinguishers
Signs & Barricading Scaffolding Safe Access/Egress De-pressurised Interlocks Required
MSDS Precautions Additional Lighting Hose Whip Check Lifting plan/Equipment Intrisically Safe Equipment
Draining Purging Vented Secure Loose Objects Manual Handling Equipment

Simultaneous opn identified and Risk accessment done Equipment Earthing & Bonding Flammables Removed Radioactivity Controls in Place

B Additional PPEs Standards-Helmets,Safety Shoes and Glasses are mandatory

Gloves-Leather Elctrical Gloves Gloves -Cotton Gloves-PVC Chemical Splash sheild
Dust Mask/SCBA Arc Flash Suit Safety Harness Steam resistant gloves & Suit Tool Box Meeting

C Job safety Analysis HIRADeC are mandatory for all work associated with safety Systems HIRADeC & SWP/WI/SOP/SMP No:

D Additional Controls
Note : Sl No 1 to 3 Needs to be filled one day in advance from the Actual Work Execution Day
4 Isolation Required
Process/Mechanical Isolations Cert No. Electrical/Instrument Isolations Cert No.

High Voltage Switching certificate Cert No.

5 Authorised By Section Head Affected Area Authority Project Head

I/we agree this work can proceedd provided all the above identified controls are in place and the precautions adheredd to by the work party
Name Signature Designation Date Time

Note : The Above Authorization is required for Identified Critical Jobs .

6 Issue

I the Shift Incharge ,declare that all hazards have been identified and all control measures are in place and it is now safe I the Field Engineer/Operator confirms that all hazards identified and all control measures specified are in place
for the work specified on this permit to be performed and is valid. and it is now safe to carry out the work specified on this permit.
hrs hrs
From : To :
Name Signature Designation Date Time Name Signature Designation Date Time

I the Performing Authority, have read and understood the above conditions and precautions. I accept responsibility for carrying out the work as specified.I will ensure the persons under my control read,understand and comply with these
conditions and precautions.I will notify the Operation Shift Incharge on completion or interruption of this work.

Name . Signature Designation Date Time

7 Permit Renewal

Date:

From:

To:

Shift Incharge (Issuer)

Performing Authority

8 Permit Sign off

Performing Authority: I declare that all persons have been withdrawn and that all tools,plant and equipment used have
been removed and the site left in a safe clean and tidy condition.
The Work is complete The Work is Incomplete
Name (print) Signature Designation Date Time

Shift In Charge ( Issuer ) I declare the work task is :- Complete Incomplete Isolations/Overrides can be removed:

Isolations/Overrides can be removed (If yes transfer Isolation Certificateto Long term Isolation Register)

Name: Signature: Designation: Date : Time:

 THDC INDIA LIMITED (2*660MW)
PERMIT TO WORK - HOT WORK PTW No:- No.:SSL/HW/

Unit No:- Date:-

1 Specification of Work Mark All Boxes Yes ,No or N/A(Not Applicable) Valid for 8 hours-After This permit Revalidation Required
Date of Application Applicant /Performing Authority Name Department
Location of Work Equipment Tag no.

Description of work
Name of Persons Working

Tools & Equipments

2 Hazards Identified
Confined Space Tripping Hazard Excavation Collapse Toxic Gas Fumes Heavy Lifts Hazardous Substances

Mechanical/Electrical Sparks Hot surface Moving Machinery Fall from Height Steam Unguarded Opening
Slipping Hazards Ackward Access Flammable Material Hydrocarbon Area Noise Pressurised Pipework

Inadequate Lighting Dropped Objects Radioactive Source Static Electricity Vibration Pressurised Hose Failure

Simultaneous opn Gas cylinders Cutting set Electrocution Others

3 Controls in Place
A Initial Gas Testing Oxygen Content Check Hose whip Check Continuous Gas Test Fire /Safety Watcher Portable Fire Extinguishers
Signs & Barriers Walki-talki required Venting PA Announcements Fire Blanket/Screen Drains flushed & covered
Charged Fire Hose Additional Lighting Ear Protection Safe Access/Egress Lifting plan/Equipment MSDS Precautions
De-Pressurised Draining Secure Loose Objects Purging Standby Fire Tender Manual Handling equipment
Equipment Earthing
Simultaneous opn identified and Risk assessment carried out Interlocks Required & Bonding Flammables Removed Emergency preparedness

Flash Back Arrestor Gas Cylinder with trolley Intrintisically Safe Equipment Arc & Flash Suit

B Additional PPEs Standards-Helmets,Safety Boots and Glasses are mandatory

Gloves-Leather Gloves -Cotton Gloves-Heat Resistent Gloves-PVC Chemical Splash sheild

Dust Mask/SCBA Safety Harness Face Sheild welding Welding Goggles Tool Box Meeting

C HIRADeC HIRADeC are mandatory for all work associated with safety Systems HIRADeC & SWP/WI/SOP/SMP No. Others

D Additional Controls
Note : Sl No 1 to 3 Needs to be filled one day in advance from the Actual Work Execution Day

4 Isolation Required
Process/Mechanical Isolations Cert. No. Electrical/Instrument Isolations Cert. No. Personal Isolations

High Voltage Switching certificate Cert. No. Description

5 Authorisation By SBU / Sectional Head Affected Area Authority Project Head

I/we agree this work can proceedd provided all the above identified controls are in place and the precautions adheredd to by the work party
Name (Print) Signature Designation Date Time
 Initial Test by Authorised Gas Tester ;Continuous Monitoring by Performing Authority /Safety Watch
6 Site Atmosphere Test : (Mandatory for Entry)

Test for: LEL O2 Other Peroidic tests to be carried out by AGT

Date Time LEL O2 Toxic CO Other Signature Date Time LEL O2 Toxic CO Other Signature

7 Issue

I the Shift Incharge ,declare that all hazards have been identified and all control measures are in place and it is now safe I the Field Engineer/Operator confirms that all hazards identified and all control measures specified are in place
for the work specified on this permit to be performed and is valid. and it is now safe to carry out the work specified on this permit.
hrs hrs
From : To :
Name Signature Designation Date Time

I the Performing Authority, have read and understood the above conditions and precautions. I accept responsibility for carrying out the work as specified.I will ensure the persons under my control read,understand and comply with these
conditions and precautions.I will notify the Operation Shift Incharge on completion or interruption of this work.

Name (Print ) Signature Designation Date Time

8 Permit Re-Issue
Date:
From:
To:
Shift Incharge
Performing Authority

9 Permit Sign off

PermitPerforming Authority I declare that all persons have been withdrawn and that all tools,plant and equipment used
have been removed and the site left in a safe clean and tidy condition.
The Work is complete The Work is Incomplete
Name (print) Signature Designation Date Time

Shift Incharge I declare the work task is :- Complete Incomplete Isolations/Overrides can be removed:

Isolations/Overrides can be removed (If yes transfer Isolation Certificateto Long term Isolation Register)

Name: Signature: Designation: Time : Date:

 THDC INDIA LIMITED (2*660MW)
VEHICLE ENTRY PERMIT FOR HYDROCARBON AREA [Link]/VE/

Unit no:- Date :-

Mark all boxes Yes,No or N/A(Not Applicable)

1 DRIVERS/VEHICLE DETAILS
Applicant:
Access Route:

Entry Purpose:

Vehicle type; (Crane/Forklift/Light vehicle/Bus/Tanker/Tractor/Digger/Buldozer etc.)

Drivers Licence: Vehicle Registration Number:

SITE SPEED LIMIT 20 Kmph NO PETROL ENGINE VEHICLE ALLOWED ON SITE

2 VEHICLE CHECKS (Minimum Requirement)

Full vehicle check required Spark arrestor fitted and in good condition: Work in hydrocarbon area of plant
No leaks in exhaust System Brakes and handbrake in working condition: Dangerous protrusions from vehicle:
Electrical wiring in good condition Lights and warning devices working:
Battery System and connections secure: oil Leaks from Engine/Transmission:

I the Authorised Person have checked the vehicle against the check list/standard and declare the vehicle meets the criteria for vehicle entry
Site Engineer/Associate Signature Designation Date Time

3 SITE SAFETY SYSTEMS

Safety Systems or Devices that may be obstructedd or compromised Details contingency plan or additional requirements

4 CONTROLS
Correct Fire Extinguisher in vehicle: Continuous Gas Test required Site road plan attached :
pre Entry Gas Test required: Periodic Gas Test required: Route barriers required and in place:
Driver/Crew Site Induction Carried out: Site escort required and available: Certificate of explosive in place:
Loose items on vehicle made secure: Driver aware of site speed limit; Valid Lifting Certificates in place:
Anti-Static bonding in place: Road worthiness : Driver aware of Site route hazards:

Additional Controls Required:

5 ATMOSPHERIC GAS TESTS (LEL)
Date Time Results Name Date Time Results Name

Date Time Results Name Date Time Results Name

6 ASSOCIATED PERMITS

Type Number Type Number Type Number

7 APPROVAL FOR VEHICLE ENTRY

I the Sectional Head approve entry for the vehicle identified as above of this permit,providing the controls are in place and precautions are adhered to

Name Signature Designation Date Time

8 SIGN ON
Vehicle driver/attendant do you understand the requirements of this permit: Are you aware of and understand the site safety rules:
Name ( Driver/Attendant) Signature Designation Date Time

I am aware of my responsibilities as escort for the vehicle identified in Section 1 of this certificate

Name ( Site Engineer/Associate ) Signature Designation Date Time

9 WORK COMPLETE
I the Site Engineer/Associate confirm the following:
The work is complete: The work site is clean and tidy: All equipment has been removed: The vehicle has been removed:

Name Signature Designation Date Time

I the Sectional Head confirm all activities associated with this vehicle is complete and the site clear

Name Signature Designation Date Time

 THDC INDIA LIMITED (2*660MW)
WORK-AT HEIGHT CERTIFICATE PTW NO:- No.:SSL/WAH/

Unit No:- Date:-

1 Specification of Work Mark All Boxes Yes ,No or N/A(Not Applicable) Valid for 8 hours-After This permit Renewal Required
Date of Application Applicant /Performing Authority Name Department
Location of Work Equipment Tag no.

Description of work
Name of Persons Working

Tools & Equipments

2 Hazards Identified
Fall from height Unguarded Opening Unguarded Opening Excavation Collapse Steam Excavation Collapse

Fall of material Ackward Access Improper scaffold Mobile access platform Pressurised Pipework
Slipping Hazards Tripping Hazard Inadequate Lighting Simultaneous Opn Noise

Collapse of structure Improper placement of ladder Heavy Lifts Temporaty platform Vibration

Fragile roof Other Hazards

3 Controls in Place
A Height pass Safety harness with double lanyard Tested scaffold with tagging Hand rails Roof holes hard baricadded
Signs & Barriers Fall arrestors Safe Access/Egress Toe baords Vertical lifelines
MSDS Precautions Additional Lighting Outrggier incase of mobile scaffold Lifting plan/Equipment Horizontal lifeline
Drained Safety net Approach ladder Secure Loose Objects Emergency rescue plan

Simultaneous opn identified and Risk accessment done Cage for fixed ladder > 2.5 m Crawling ladder Supervsion

B Additional PPE Standards-Helmets,Safety Boots and Glasses are mandatory

Gloves-Leather Gloves -Cotton Gloves-PVC Chemical Splash sheild
Dust Mask/SCBA Ascendor/Dyscendor /Rope Crab Steam resistant gloves & Suit Tool Box Meeting

C Job safety Analysis HIRADeC are mandatory for all work associated with safety Systems HIRADeC & SWP/WI/SOP/SMP No:

D Additional Controls Head count Register etc

4 Authorised By SBU Head Section Head

I/we agree this work can proceed provided all the above identified controls are in place and the precautions adhered to by the work party
Name (Print) Signature Designation Date Time

5 Issue

I the Section Head ,declare that all hazards have been identified and all control measures are in place and it is now safe I the Shift Incharge confirms that all hazards identified and all control measures specified are in place and it is now
for the work specified on this permit to be performed and is valid. safe to carry out the work specified on this permit.
From : To :
 I the Section Head ,declare that all hazards have been identified and all control measures are in place and it is now safe I the Shift Incharge confirms that all hazards identified and all control measures specified are in place and it is now
for the work specified on this permit to be performed and is valid. safe to carry out the work specified on this permit.
hrs hrs
From : To :
Name (Print) Signature Designation Date Time

I the performing Authority, have read and understood the above conditions and precautions. I accept responsibility for carrying out the work as specified.I will ensure the persons under my control read,understand and comply with these conditions
and precautions.I will notify the Area Authority on completion or interruption of this work.

Name (Print ) Signature Designation Date Time

6 Certificate Renewal
Date:
From:
To:
Shift Incharge
Receiving Authority

7 Certificate Sign off

Performing Authority: I declare that all persons have been withdrawn and that all tools,plant and equipment used have
been removed and the site left in a safe clean and tidy condition.

The Work is complete The Work is Incomplete

Name (print) Signature Designation Date Time

Shift In Charge: I declare the work/task is :- Complete Incomplete

All materials removed from site Housekeeping done

Name: Signature: Designation: Time : Date:

 THDC INDIA LIMITED (2*6
EXCAVATION CERTIFICATE PTW NO:-

Unit No:-
Mark all boxes Yes,No or N/A(Not Applicable)

Date of issue Time:

1 SPECIFICATION OF EXCAVATION
Applicant: Discipline
Excavation by:
Area/Location:

Description of Work:
Name of Persons Working

Extent or Excavation: Width: Length:

Tools/Equipment to be used:

2 HAZARDS:
Confined Space Tripping Hazard Excavation Collapse

High Pressure jet Simultaneous Opn Unguarded Opening:

Slipping Hazard: Awkward access: Flammable materials

Inadequate Lighting Dropped Object: Radioactive source:

Other Hazards:

3 CONTROLS
Drawings are attached to certificates: Underground service drawing checked:

work/site area Gas Test required: Driver/crew Site Induction carried out:

Access/Escape Route(s) identified: Valid lifting Certified in place:

Additional lighting available /in place: Fire /Emergency Equipment available:

Simultaneous Opn carried out: Additional Controls Required:

Electrical Systems in Excavation Area: Are drawings available to show location/depth of cab
 I confirm the isolations are in place:

Mechanical Maint Systems in Excavation Area: Are drawings available to show location/dep

I confirm the isolations are in place:

Process/Utility Systems in Excavation Area: Are drawings available to show location

I confirm the isolations are in place:

Instrumentation Equipment in Excavation Area: Are drawings available to show location/d

I confirm the isolations are in place:

IT & Telecom Equipment in Excavation Area: Are drawings available to show location/depth of eq

I confirm the isolations are in place:

I declare that the above checks have been carried out,the relevant isolation and controls are in place ready for the excava
Name of Performing Authority Signature

4 ASSOCIATED PERMITS/CERTIFICATES:
Type Number Type Number

5 AUTHORISATION BY Sectional Head: Project Head:

I/We agree the activities identified as above of this certificate can proceed providing the controls are in place and precau
to work
Name Signature Des

6 ISSUE

I,the Shift In Charge declare that all the hazards have been identified and all controls are in place and it is now safe for the
Name Signature Des

7 Certificate RE ISSUE
 Date:
From:
To:
Shift Incharge
Performing Authority

8 WORK COMPLETE
I the Shift In Charge confirm all activities associated with this excavation work are complete.
The excavation is Open and barriers erected aroud this excavation site: The excavation is Closed

Name Signature Des

MITED (2*660MW)
[Link]/EP/

Date:-

Expiry date: Time:

Discipline Company
Company

Depth

Toxic Gas Fumes Heavy Lifts Hazardous Substance

Working at Height: Steam: Pressurised Pipework:

Hydrocarbon area: Noise: Pressurised Hose failure:

Static electricity: Vibration: Electrical hazard

Safety barriers required/in place:

Shoring required/available at the site:

Driver aware of site route hazards:

Additional PPE available:

ow location/depth of cables: Can the Systems be safely isolated:

 Signature: Date: Time:

ble to show location/depth of pipework etc. Can the Systems be safely isolated:

Signature: Date: Time:

vailable to show location/depth of facilities: Can the Systems be safely isolated:

Signature: Date: Time:

lable to show location/depth of equipment: Can the Systems be safely isolated:

Signature: Date: Time:

how location/depth of equipment: Can the Systems be safely isolated:

Signature: Date: Time:

ace ready for the excavation work identified as above.

Designation Date: Time:

Number Type Number

ct Head: Shift Incharge :

are in place and precautions are adhered to and executed through the appropriate and approved Permit

Designation Date Time

and it is now safe for the sxavation /penetration work to proceed

Designation Date Time
he excavation is Closed and the work site clean and tidy:

Designation Date Time

 THDC INDIA LIMITED (2*660MW)
CONFINED SPACED ENTRY CERTIFICATE PTW No:- No.:SSL/CS/

Unit No:- Date:-

1 Specification of Work Mark All Boxes Yes ,No or N/A(Not Applicable) Valid for 8 hours and it is restricted upto 6 pm only
Date of Application Applicant /Performing Authority Name Department
Location of Work Entry Description

Test for: LEL O2: Toxic: CO: Other: Test Equipment used:

Name of Persons Working

2 Isolation Required Process/Mechanical Isolations: Permit. No. Electrical/Instrument Isolation: Permit. No.

3 Hazards Identified for Entry

Confined Space: Ackward Access Excavation Collapse Toxic Gas Fumes Noise: Hazardous Substances

Dropped Objects: Slipping Hazard: Tripping Hazard: Hydrocarbon :: Heat: Airborne Particles e.g. Dust:

Entrapment: Engulfment: Flammable Material Adverse Weather: Traffic: Inadequate Isolations:

Inadequate Lighting Unguarded Opening: Radioactive Source Simultaneous Opn Other Hazards:

4 Controls in Place For Entry

Safety Watcher Rescue Equipment Available: Safe Access/Egress: Gas Detector Callibrater: Breathing Apparatus Available :
Signs & Barriers Walky Talky Available & Tested: Safety Harness & lifeline: Isolation in Place & verified: Inhibits/Overrides Required
De Pressurised: Draining: Purging: Venting: Excavation Supports in Place:
Ventilation Provided Additional Lighting in Place: Face Mask with Filter : Ear Protection: Chemical suit:

Additional PPES Fire service Informed: Ambulance Informed 24 volt lighting source Emergency preparedness

Exhaust & Blower Manhole opened Emergency exit Additional control required

5 Authorisation for the Initial Testing and Inspection: SBU Head Sectional Head Project In Charge

The work to test and inspect the confined space can proceed provided all the above identified controls are in place and precautions being adhered to.
Note: This activity must be carried out in accordance with the guideline for confined space entry
Name Signature Designation Date Time

6 Issue for Initial Testing and Inspection:

I the Sectional head declare that all controls as specified above are in [Link] Authorised Gas Tester can, in I the Authorised Gas Tester, have read and understand the above conditions and precautions specified.I accept
accordance with the controls and precautions, test the space and if conditions meet the approved responsibility for carryig out atmospheric testing and inspection of the nominated confined space.I will ensure the
criteria,they can enter the space for the purpose of inspecting to establish the suitability of the space for work persons under my control read and understand an comply with these conditions and precautions.
to be performed.

Name Date: Name: Date:

Signature: Signature: Time:
Designation:

7 Initial Atmosphere /Gas Test Results: (Successive Atmospheric /Gas Tests are to be carried out as indicated below)
Agent Entry without BA Entry with BA Date Time Result Name Signature
O2 20%-21% 16.5% - 20%
LEL Less than 1% 1%-10%
Toxic TLV STEL Value
CO 50 ppm Max 200ppm Max
 Other

8 Permits and HIRADeC Associated With this Entry permit and Additional Controls

Cross Referenced Permits No. No. No. No.

HIRADeC No: HIRADeC are Mandatory for all work associated with Confined Space Entry

Ventilation Required: Entry with BA Only: Entry with Airline and Hood: Toolbox Talk:

9 Authorisation for Entry to work in the Confined Space: SBU Head Sectional Head Project In Charge

Entry into the confined space identified in Section 1 may proceed to perform the work identified on the permits numbered in section 8 of this certificate, provided all the entry controls remain in place, the additional controls identified in
section 8 and JSA recommendations are applied and subject to testing of the atmosphere in accordance with the stipulated frequency.

Name Signature Designation Date Time

10 Issue for Entry to Carry out Work:

I the Shift In Charge declare that all entry controls are in place and JSA/HIRA recommendations applied and the work I the Performing Authority for the work to be undertaken inside the confined space,have read and understand the
identified on the Permits listed above can proceed,subject to the following gas testing programme being applied: conditions and precautions specified above and the JSA/HIRA.I will abide by these and will ensure the persons under
my control adhere to these conditions.

Continuous Gas Test: Intermittent Gas Test: Frequency:

Name: Date: Name: Date:

Signature: Time: Signature: Time:
Designation: Designation:

11 Certificate Renewal
Date:
From(Time):
To(Time):
Shift In Charge
Performing Authority

12 Certificate Closure
Performing Authority: I declare that all personnel have been withdrawn,Permits closure and that all tools and equipment used have been removed from the confined space associated with this certificate and the area left in a
safe clean and tidy condition.

Thw Work is Complete: The Work is Incomplete: The status of the work being:

Name: Signature: Designation: Date: Time:

Sectional Head:This permit is now void and no further entry is permitted

Name: Signature: Designation: Date: Time:

 THDC INDIA LIMITED (2*660MW)
HIGH VOLTAGE SWITCHING CERTIFICATE ( > 6.6 KV )
EL Permit No. SSL/EL/ PTW No:- SOP/WI No

Unit No:- Date:-

1 ISOLATION Mark All Boxes
Equipment covered by this permit:
Tag Numbers:

LOTO Key No
Switching Programme Attached: Isolation: De-isolation:

Name of Persons Working:

REQUEST FOR ISOLATION SWITCHING PROGRAM PREPARED BY
Name Name

Signed Signed

Time Time
Date Date

Sanction to test may be requested by Permit Recipient:

Name Signed

Time Date

ISOLATION PERFORMED BY
Name Dicipline

Signed Time

ISOLATION CHECKED BY
Name Dicipline

Signed Time

PERMITS ASSOCIATED WITH THIS ELECTRICAL CERTIFICATE

Permit Nos. SSL/ SSL/ SSL/

The above equipment preparations and precautions have been adhered to.I will abide by the conditions of the attached SOP/WI

Name Discipline

Signed Time

Work Complete: All men/materials/tools removed:

2 DE-ISOLATION
REQUEST FOR DE-ISOLATION
Name Dicipline

Signed Time

DE-ISOLATION APPROVAL
Name Dicipline

Signed Time

DE-ISOLATION COMPLETE
Name Dicipline

Signed Time

I CONFIRM DE-ISOLATION COMPLETE -THE EQUIPMENT CAN BE RESTORED TO NORMAL OPERATING CONDITION
Name Discipline

Signed Time
 (2*660MW)
FICATE ( > 6.6 KV )
SOP/WI No

Yes,No or N/A(Not Applicable)

SWITCHING PROGRAM CHECKED BY

Name

Signed

Time
Date

A SANCTION TO TEST MUST BE AUTHORISED BY THE

SECTIONAL HEAD AND IDENTIFIED ON THE
ASSOCIATED PERMIT

Date

Date

CAL CERTIFICATE
SL/ SSL/

ditions of the attached SOP/WI

Date

Earthing Equipment Removed:

 Date

Date

Date

TING CONDITION

Date
 THDC INDIA LIMITED (2*660MW)
ISOLATION CERTIFICATE PTW No:- No.:SSL/IC/

Unit No:- Date:-

1 ISOLATION REQUEST Mark All Boxes Yes ,No or N/A(Not Applicable)
Plant/System to be isolated:
Equipment Number: Location:
Reason for Isolation:

Type of Isolation Required: Process / Mechanical: Electrical : Instrument:

Detail of associated equipments/items

isolated

Isolation Job Safety Analysis Required JSA No.: Drawings Attached:

P & ID/Electrical Drawing Numbers:

Name of Requester Signed: Date: Time: hrs.

2 ISOLATION CONTROL
HAZARDS and PRECAUTIONS
Hazards:

Precautions:

SAFETY SYSTEMS

What systems or devices will be comprised:

Detail contingency plans:

HV Isolation required: Certificate Number: Switching Plan/Procedure Number:

ASSOCIATED PERMITS/CERTIFICATES

Type Date Issued Description of work Date Cancelled Shift Incharge Name Signature

APPROVAL TO ISOLATE
I the Shift Incharge declare that the plant/equipment identified in Section 1 is safe and available for isolations to be made in accordance with SSL safe Work Practice on Process/Mechanical and
Electrical [Link] isolations to be applied are listed in section 2a(Isolations record).

Name: Signature: Date: Time hrs

 ISOLATION CONFIRMATION
I the Shift Incharge declare that the isolations listed in 2a are in place and tagged and the plant/equipment described in Section 1 is now in a safe condition for work to commence.

Name: Signature: Date: Time: hrs

3. ISOLATION CERTIFICATE REGISTRATION

Name: Signature: Date: Time: hrs

4 DE-ISOLATION CONTROL
Sanction to Test:I the Shift Incharge authorise the temporary de-isolation for test purposed the equipment identified in the attached 2a isolation record.
Name: Signed: Date: Time: hrs

De-Isolation:I the Shift Incharge declare that the work carried out under this certificate is now complete and all concerned permits and Certificates have been signed off and relevant work parties have
been informed that work authorisation is withdrawn.
All isolations associated with this isolation certificate can now be removed.

Name: Signed: Date: Time: hrs

Return to Service:I the Shift Incharge declare that all isolations have been removed from the plant/equipment specified on this [Link] plan/equipment can be returned to normal service.
This Isolation Certificate is now Cancelled.

Name: Signed: Date: Time: hrs

De-Registration:The permit register has now been updated to show that this Isolation Certificate has been cancelled and normal operations can safely proceed.
Name: Signed: Date: Time: hrs

5 LONG TERM ISOLATION CONTROL

The Permits associated with this Isolation Certificate have now been cancelled but the Isolations must remain in place for the following reasons

Name: Signed: Date: Time: hrs

6 AUDIT RECORD
Audit has been carried out on this Isolation Certificate
Name: Signed: Date: Time: hrs
Title of Auditor:
 THDC INDIA LIMITED (2*660MW
ISOLATION RECORD SHEET PTW No:-
Unit No:- Date :-
1 ISOLATION REQUEST
Plant/System to be isolated

Equipment Number Location

2a ISOLATION RECORD
PROCESS / MECHANICAL ISOLATIONS
ISOLATION

No Tag No. Item Open/Closed Locked Lock no. Tagged Date Signed
Description

ELECTRICAL ISOLATIONS
ISOLATION

No Tag No. Item Open/Closed Locked Lock no. Tagged Date Signed
Description
INSTRUMENT ISOLATIONS
ISOLATION

No Tag No. Item Open/Closed Locked Lock no. Tagged Date Signed
Description

Isolation Types: Process Mechanical

Isolation Requirements (Process & Mechanical) Blank Disconnect

Isolation Requirements (Process & Mechanical) Disconnect Earthed

ED (2*660MW)
PTW No:- [Link]/IC/

Date :-

Location

SANCTION TO TEST
DE-ISOLATION RE-ISOLATION DE-ISOLATION

Date Signed Date Signed Date Signed

SANCTION TO TEST
DE-ISOLATION RE-ISOLATION DE-ISOLATION

Date Signed Date Signed Date Signed

 SANCTION TO TEST
DE-ISOLATION RE-ISOLATION DE-ISOLATION

Date Signed Date Signed Date Signed

Electrical Instrument

Spade Valve
Switch Open
Valve
Fuse Removed Proved Dead
 THDC INDIA LIMITED

DOC NO: THDC/SESI/OPN/LS/F008 PTW REGISTER

PTW/ Order
[Link] Date Time Hrs Deptt. Equipment LOTO Details
No.
THDC INDIA LIMITED ( 2*660 MW )

PTW REGISTER
Signature of
Cleared By
Reason For Release Release By Release To the taking Time Hrs Date
(Maint. Person)
person
MONTH :
YEAR :

Shift Charge SAP

Remarks
Engineer CLOSED