QUALITY MANAGEMENT SYSTEM _| Document No. QF-GEN-17(6) QUALITY FORM Effective Date: 07 May 14 TITLE: PERMIT TO WORK Page 1 of 1 HARIPUR 412 MW COMBINED CYCLE POWER PLANT: EGCB LTD. PERMIT TO WORK ‘Valid for period From To ISSUE DATE UNIT: AREA: DEPT: PTWNo. EQUIPMENT DEFECT DESCRIPTION, WORK TO BE DONE: ISOLATIONS ‘SINo | Description Done By DATE & TIME: NAME & DESIGN: SIGN: Further precautions to be taken by recipient: KINDLY TAKE CARE OF MEN & MACHINE ISSUE Key safe no: have confirmed with these control persons that isolations have been done and will be maintained till the permit, is cancelled, ‘TIME & DATE: NAME & DESIGN : SIGN: RECEIPT |Tunderstand and accept my responsibilities for PTW ‘TIME & DATE: NAME & DESIGN: sig CLEARANCE Teerify that all persons working under this PTW have been withdrawn from the Plan HV apparatus and warmed ‘ot to continue work / test. All equipments, tools, loose materials and drain earths are removed, guards and access doors refited Brief description of Work Done: TIME & DATE: NAME & DESIGN: SIGN: ‘CANCELLATION Testify that PTW has been returned and these control persons have been informed that PTW is cancelled and of any restrictions on returning plant / HV apparatus to service, TIME & DATE: NAME & DESIGN: SIGN: Reviewed by (MR) ‘Approved by (MD)