Permit Ptw

PERMIT TO WORK (P T W) HIGH VOLTAGE - ELECTRICAL ACTIVITY – ELECTRICALLY DRIVEN EQUIPMENT PART 1- The Request for a Permit (To be completed by supervisor or sub-contractors supervisor and submitted to the Approved Permit Issuer- Engineer – HOD, Supervisor must be in his direct control) ) Name of company Location of work. Nature of work to be undertaken including points of isolation, positions of Circuit Main Earths and which ones may be temporarily removed under IEE rules Reference of any approved method statement that is relevant to this request Acknowledgement: I understand the hazards of this work and the precautions to be taken. I have ensured that these have been fully explained to the operatives carrying out this work, and consider them to be competent to do it safely. I will closely supervise these works to ensure that they are carried out in accordance with the terms of this permit and I will return my copy of this permit to the Approved Permit Issuer when this work has been safely completed. Signature:

time:

Date

PART 2- The Authorization for Work to proceed (to be completed by the Approved Permit Issuer) Validation: I confirm that I have checked that the control measures detailed here in all are in place and therefore within the limitations below, the equipment / systems described above in section 1 is safe to work on / test Permit valid from hrs………………on date……………to hrs on date………………. It is accepted by ………..........(Name- initials - card no.)…………position……contact…… Authorized by………………………………..Approved permit issuer…………….

Time extension from………hrs, on dated………to………hrs on dated………………….

Authorized by……………………………Approved permit issuer……………………

PART 3 – The Cancellation (to be completed by the activity supervisor and / or the Approved Permit Issuer) I hereby declare that the work detailed in section 1 has been completed / suspended and that all persons under my charge have been withdrawn from the specified work area and warned that this Permit – to - work has now been cancelled and that all tools, additional earth and all other connections are clear and that the equipment with the exception of that below is ready for service. Exceptions: Signature…………………………supervisor , time hrs………………date………………. I hereby declare the work undertaken under this Permit has been completed / stopped and that the permit has been cancelled Signature……………….......Approved permit issuer………time hrs……….date…………… CHECKLIST FOR PERMIT TO ELECTRICAL, HIGH -MEDIUM LOW - VOLTAGE WORK (ATTACH SHEET IF REQUIRED) Control measures (tick if applicable, write n / a if not) Approved risk assessment / method statement is attached Other permits are available (e.g. Utility Provider, etc) Disconnections done (detail where & how) Fire / smoke detection equipment disconnected Apparatus proved dead (detail what tests made below) Fire extinguishers in place Adjacent live equipment presents (state precautions taken) Personal Protective equipment available, active , in use Danger and caution notices posted (state where) Access Control (state where displayed)

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n / a, not applicable

Atmospheric conditions are humid (state precautions taken if humid) Temporary lighting available Earthing is in place (state where apparatus earthed) Competent person appointed First aid support available Safety locks fitted / tagged (LOTO) (specify location) Emergency procedures in place (specify) Other precautions (specify)