NTPC LTD.

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Simhadri Thermal Power Project Duplicate
LIMITED WORK CERTIFICATE
Unit 03 Issue Date:05.02.2018 10:57:07
LWC No.300002449071 WA No.100006351844

Valid From : 05.02.2018 10:57:07 Valid To : 11.02.2018 24:00:00

(To be used for Plant or High Voltage, Medium & Low Voltage Apparatus Only)
1. (i) Functional Location:1035-S2U03 STAGE02, UNIT 03, 500MW
Equipment:

(ii) Maint Order No: 304238190 PAINTNG WORKS U#3 BOILER TURBINE AREA

2.(i) State limits of work or testing or limits of work area state any safety precautions applied, caution notices applied :

(ii) State any further precautions to be taken by recipient during work to avoid danger from the system:

I (SAP) have confirmed with these control persons( ) that precautions in 2(ii) have been applied
& control person(s) will maintain these until LWC is cancelled. I certify safety precautions as above are adequate to
provide safety from the system for work or testing given in section 1 of this LWC.
Signed:__________(SAP) Time:10:57:07 Date:05.02.2018 Prepared by:VENKANNA BALLA

3. ISSUE: Key Safe Key No._________ No of safety keys issued.:________________

Control person agreeing to issue of LWC(safety rule F-4-2-1)_____________________
Approved persons report no._____________
Signed:__________(SAP) Time:10:57:07 Date:05.02.2018 Issued by:VENKANNA BALLA

4. RECEIPT: I understand and accept my responsibilities for LWC and received items in section 3
Signed:________ (Comp. Person) Name:Koyya Chinna Apparao Issued to Deptt:OFFSITES STAGE2

5. CLEARANCE: I certify that all persons working under this LWC have been withdrawn from the plant/HV apparatus &
warned not to continue work/test on the plant/HV apparatus. All equipments, tools, loose material and drain earths are
removed, guards & access doors refitted. State any EXCEPTIONs to above:
_____________________________________________________________________________________(or write nil).
I also confirm that the waste generated during the job is cleared. Any other environmental impact:
_______________________________________________________________________________
Signed:_______(Competent Person) Time:______Date:_________Name:___________________

6. CANCELLATION: I certify that all items issued in section 3 have been returned to me or are accounted for & these
control persons________________ have been informed LWC is cancelled and of any restrictions on returning plant/HV
apparatus to service.
Signed:_____________(SAP) Time:_______Date:_________Name:____________________