ELECTRICAL WORK PERMIT

PROJECT: ___________________________________ JSA No.____________________________________

Name of the Contractor _________________________ Date of permit issue __________________________
Permit validity from___________ to________________ Permit type_________________________________
Location of Job: _______________________________ Permit extension_____________________________
Nature of Job: Tick (Maintenance, Charging, Testing, Commissioning, Power extension) ____________________
Safety precautions (Tick mentioned below)

Sl. No Counter Measures YES NA

1. Daily housekeeping of the work area completed. Combustible material kept clear from electrical
2. fixtures.
Fiber ladder is provided for the LIVE panel area
3. Lock out / Tag out system provided.
4. All electrical tools, equipment’s are insulated and checked.
5. Appropriate Safety Signage’s displayed
6. Cables and connections in good condition (no deterioration)
7. No joints in cables by insulation tape, cable connector used
Disconnected electric supply before starting work on Live equipment. Residual energy in the system
8.
drained prior start of work
9. Generator/transformer/panel are in enclosed condition & double earth provided.
10. Cables properly protected, bundled, and kept as clear as possible at exits
13. PPE’s / Safety Gadgets as applicable
Safety Rubber
Safety HV Electrical Reflective Voltage Induction Gum HV Hand Ear
Type Helmet Safety Shoe waist tester tester
Goggles
Boots Gloves Plug
Harness mats

Tick
Night Work Precautions
14. General area & task Illumination is provided and secured properly
15. Emergency vehicle and driver available at standby
a. Non-compliance observed at work place to be closed prior commence of night work
16. b. Continues on job supervision to be available for the night works

Any Remark_______________________________________________________________________________________

__________________________________________________________________________________ (Contractor/PMC)

The below signing person will be responsible to ensure that the above described work will be done under all the safety precautions
mentioned on the permit and job safety analysis as required by the project.
Electrician Detail :
Name of Electrician : _________________ Badge Number (B License)_________________ Valid Till________________

Permit Closing Details

(Physically verified site conditions for all safety aspects in
Permit requesting by Contractor Permit approved by-PMC place)
Sign Sign Sign Sign Sign Sign Sign

Time Time Time Time Time Time Time

Site Engineer HSE – S/C Site Engineer PMC - HSE Site Eng. S/C HSE – S/C PMC - HSE

PTWS – ELECTRICAL WORK PERMIT - R1 - 10.03.2017 Page 1 of 1