Electrical Isolation Work Permit

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Client's Engineer's Contractor's


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ELECTRICAL ISOLATION WORK PERMIT

PERMIT TO WORK NO: DATE:


PROJECT: LOCATION:
CONTRACTOR: CONSULTANT:
EMPLOYER:
PURPOSE OF ISOLATION:

No voltage checking and


PERMITS REQUIRED: Removal of contactor carriage Warning notice posted
testing
Field control switch off & Removal of control
Earthing at cubical Pad lock applied
locked off fuses/MCB switched off
Switch main isolator to off Main fuses removed and kept Earthing switch breaker Isolation details recorded
position in safe custody closed in isolation register
Shutter locked – mechanism Earthing through external
Main isolator locked off  other
check earths

CONTROL MEASURES:

SUPPORTING
 confined space entry cert.  excavation checklist  list of personnel
DOCUMENTS:
 task risk assessment  method statement  drawings  tool box talk record

REVIEW AND AUTHORIZATION:


I, the approving authority, have inspected the work area and hereby confirm it is safe to perform this task under the conditions of
this permit.
Name:………………………………….………….… Signature……………………………………….. Date…………..
……………………...
I, the permit coordinator, have reviewed this permit and supporting doc.s and confirm that they are in compliance with the permit
procedure.
Name:………………………………….………….… Signature……………………………………….. Date…………..
……………………...
I, the performing authority, accept the conditions stipulated in this permit and confirm that all control measures and isolations are in
place.
Name:………………………………….………….… Signature……………………………………….. Date…………..
……………………...

CLOSE OUT:
 THE WORK IS COMPLETE
 THE WORK IS INCOMPLETE AND LEFT IN THE FOLLOWING CONDITION (STATE REASON):
Performing authority:I declare that the work for which this permit was issued has been properly performed, and that the area has
been left in a safe, clean, condition.
Name:………………………………….………….… Signature……………………………………….. Date…………..
……………………...
Approving authority:I have inspected the work area and declare that the work for which this permit was issued has been properly
performed, and that the area has been left in a safe, clean,
Name:………………………………….………….… Signature……………………………………….. Date…………..
……………………...
PTW coordinator:I declare that this permit to work has been closed out as per permit to work procedure and been logged into the
permit to work register under the document control group (DCG)
Name:………………………………….………….… Signature……………………………………….. Date…………..
……………………...

Electrical Isolation Work Permit

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