Live Permit To Work
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LIVE PERMIT TO WORK WORK REQUEST No. ----------------PTW No. ----------------
(A) ISSUE 1. Issued to -------------------------------------------- of ------------------ Valid until: --------------------2. Plant/Equipment work will be done -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------3. Brief description of work to be done --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------4. Safety Precautions to be taken: ------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I hereby declare that I have checked the situation; it is safe to work on the above mentioned plant/equipment in LIVE. SIGNED: ---------------------------Senior Authorized Person
Time: ---------------------
Date: -------------------
(B) RECEIPT I herby declare that I am thatisfied to work on above Mentioned plant/equipment in LIVE safely. SIGNED: --------------------------Time: -------------------Authorized Person Maintenance
Date: -------------------
(D) CLEARANCE I hereby declare that the work has been completed, all staff under my supervision have been informed, tools and/or scaffolding removed, the work site has cleacred. SIGNED ---------------Time: ----------------Authorized Person Maintenance
Date: -----------------------
(E) CANCELLATION I hereby declare that the work site has been cleared and it is ready for service. SIGNED: -----------------Senior Authorized Person
Time: ----------------
Date: --------------------------
LIVE PERMIT TO WORK WORK REQUEST No. ----------------PTW No. ----------------
(A) ISSUE 1. Issued to -------------------------------------------- of ------------------ Valid until: --------------------2. Plant/Equipment work will be done -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------3. Brief description of work to be done --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------4. Safety Precautions to be taken: ------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I hereby declare that I have checked the situation; it is safe to work on the above mentioned plant/equipment in LIVE. SIGNED: ---------------------------Senior Authorized Person
Time: ---------------------
Date: -------------------
(B) RECEIPT I herby declare that I am thatisfied to work on above Mentioned plant/equipment in LIVE safely. SIGNED: --------------------------Time: -------------------Authorized Person Maintenance
Date: -------------------
(D) CLEARANCE I hereby declare that the work has been completed, all staff under my supervision have been informed, tools and/or scaffolding removed, the work site has cleacred. SIGNED ---------------Time: ----------------Authorized Person Maintenance
Date: -----------------------
(E) CANCELLATION I hereby declare that the work site has been cleared and it is ready for service. SIGNED: -----------------Senior Authorized Person
Time: ----------------
Date: --------------------------
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