WORK PERMIT /‫ﻣﻝ‬ ‫ﺗﺻﺭ‬

WP is valid for 24hr can be extended daily for another 6 days / ‫ﺃ ﺭ‬ ‫ﻣ ﻣﺩ ﺳﺗ ﺃ‬ ‫ﻣﻛﻥ ﺗﻣﺩ ﺩ‬ ‫ﺷﺭ ﻥ ﺳ‬ ‫ﻝ ﻣﺩ ﺃﺭﺑ‬ ‫ﻣ‬ ‫ﻣﻝ ﺳ ﺭ‬ ‫ﺗﺻﺭ‬

Date / ‫ ﺗﺭ‬: 18/4/2018 Time / : 3:00 PM Work Duration / ‫ﻣﻝ‬ ‫ ﻣﺩ‬: 24 HOURS PTW No / ‫ﻣﻝ‬ ‫ ﺭ ﺗﺻﺭ‬:

Related WP / ‫ﺻ‬ ‫ﺫ‬ ‫ ﺗﺻ ﺭ‬: WP#

Contractor # / ‫ﺭ ﻣ ﻝ‬: CP-117 Permit Requestor / ‫ﺗﺻﺭ‬ ‫ﻁ‬ Mohamed Rady Mobile No / ‫ﻣ ﺑ ﻝ‬ ‫ﺭ‬: 01006664161
Equip. Desc./ ‫ ﺻﻑ ﻣ ﺩ‬: System / ‫ﻧﻅ‬: EY Unit / ‫ﺩ‬
: 1
sst transformer Equipment Tag #:
Work Description / ‫ﻣﻝ ﻣﻁ‬ ‫ﺻﻑ‬

cable testing (continuity)

Does the work involve special activities? / ‫ﺻ ؟‬ ‫ﻣﻥ ﻻ ﻣ ﻝ‬ ‫ﻣﻝ ﺗﺗﻁ‬ ‫ﻝ ﻁﺑ‬
Confined Space Entry / ‫ﺩ ﻝ ﻻﻣ ﻛﻥ ﻣﻐ‬ High Voltage / ‫ﺟﺩ‬ Operating System / ‫ﺗﺷﻐ ﻝ‬ ‫ﻣﻧﻅ ﻣ ﺗ‬
Hot Work / ‫ﻣ ﻝ ﺳ ﻧ‬ Energized Panel / ‫ﺟ ﺩ ﻛ ﺭﺑ‬ ‫ﻛﺑﻧ ﺗ‬ Excavation / ‫ﺭ‬
Removal of Flooring / ‫ﻷﺭﺿ‬ ‫ﺇﺯ‬ Pressurized line / ‫ﻣ ﺳ ﺭ ﻣﺿﻐ ﻁ‬ Others / ‫ﺭ‬ ‫ﻣﻝ‬
If YES to any of the above then complete the relevant certificate and attach to the WP. Also attach risk assessment form.
. ‫ﻛﺫ ﺟ ﻥ ﻧﺭ ﻣ ﺩ ﺑﺗ ﻝ ﻻ ﻁ ﺭ ﻣﺻ ﺑ ﻣﻝ ﻛ ﺗ ﺩ‬.‫ﻣﻝ‬ ‫ ﺟ ﻥ ﻧﺭ ﻻ ﺭ ﻻﺯﻣ ﻣ ﺗﺻﺭ‬, ‫ﺳ ﺑ ﺯﻛﺭ‬ ‫ﺃ ﻣﻥ ﻧﺷ ﻁ‬ ‫ﺇﺫ ﻛ ﻧ ﻹﺟ ﺑ ﻧ‬
LOTO (attached) / ( ‫ﺯﻝ )ﻣﻁ ﺑ‬ ‫ﻁ‬ YES / ‫ﻧ‬ NO / ‫ﻻ‬ Risk Assessment (attached) ( ‫ﻣ ﻁﺭ ) ﻣﺭ‬ ‫ﺗ‬ YES / ‫ﻧ‬ NO / ‫ﻻ‬
Other Contractors related to this Work Permit / ‫ﻣﻝ‬ ‫ﺻ ﺑ ﺫﻩ ﺗﺻﺭ‬ ‫ﺭﻯ ﺫ‬ ‫ﻥ‬ ‫ﻣ‬
Contractor # ‫ﻝ‬ ‫ﻣ‬ ‫ﺭ‬ Name / ‫ﻻﺳ‬ Signature / ‫ﺗ‬
Contractor # / ‫ﻝ‬ ‫ﻣ‬ ‫ﺭ‬ Name / ‫ﻷﺳ‬ Signature / ‫ﺗ‬
Contractor # / ‫ﻝ‬ ‫ﻣ‬ ‫ﺭ‬ Name / ‫ﻷﺳ‬ Signature / ‫ﺗ‬
List Operating Areas Affected Special Conditions Required / ‫ﺋﻣ‬ ‫ﻣﻝ ﻣﻁ‬ ‫ﻣﻧ ﻁ ﻣﺗ ﺛﺭ ﻧﺗ ﺟ‬ ‫ﺻ‬ ‫ﺗ ﻁ‬

Permit Condition Acceptance / Signatures/ ‫ﺗﺻﺭ‬ ‫ﻣ‬ ‫ﺗﺻﺩ‬ Contractor WP Responsibility / ‫ﻝ ﻣﺳﺋ ﻝ ﻥ ﺗﺻﺭ‬ ‫ﻣ‬
I certify that proper safety precautions have been taken in accordance with the golden rules of safety and all workers involved in this job task have received a safety brief and fully
understood all permit conditions required. No work tasks will be performed except those listed on PTW.

WP Authorizes Name / ‫ﺳ ﻣﺳﺋ ﻝ ﻣﻝ‬ Mahmoud el badawy Authority /HSE Name:

Sign/ ‫ﺗ‬ Mobile No /‫ ﺭ ﻣ ﺑ ﻝ‬01005276660 Sign ‫ ﺗ‬/
Contractor Construction/ Commissioning Manager/…………………………....................... Site Manager /…………………………………… As required
PGESCo WP Approval PGESCo WP Issued
Comm & SU Mech. Elect. I&C Const. Civil. PGESCo Operations:
Name / ‫ﻻﺳ‬ Name / ‫ﻻﺳ‬
Signature / ‫ﺗ‬ Signature / ‫ﺗ‬
Date / ‫ﺗﺭ‬: Time / Date / ‫ﺗﺭ‬: Time /
As Req. PGESCo SU/Oper. Manager: As Req. PGESCo HSE:
Permit Revalidation / ‫ﻣﻝ‬ ‫ﺗﺟﺩ ﺩ ﺗﺻﺭ‬
Day 2 Date Sign Day 5 Date Sign
Day 3 Date Sign Day 6 Date Sign
Day 4 Date Sign Day 7 Date Sign
WP Hold / ‫ﻣﻝ‬ ‫ﻑ ﺗﺻﺭ‬
Permit Requestor shall remove all locks and tags and return Work Permit to PGESCo and no further work may be conducted until Work Permit is released

Permit Requestor name: PGESCo Operations:

Signature / ‫ﺗ‬ Signature / ‫ﺗ‬
Date / ‫ﺗﺭ‬: Time / Date / ‫ﺗﺭ‬: Time /
WP Release / ‫ﻣﻝ‬ ‫ﺩ ﻻﺳﺗﻛﻣ ﻝ‬ ‫ﺑ‬ ‫ﺳﻣ‬
Permit Requestor name: PGESCo Operations:
Signature / ‫ﺗ‬: Signature / ‫ﺗ‬
Date / ‫ﺗﺭ‬: Time / Date / ‫ﺗﺭ‬: Time /
Work Completion / ‫ﻣﻝ‬ ‫ﻻﻧﺗ ء ﻣﻥ ﺗﻧ ﺫ‬
The plant has been restored to normal & safe condition and all Tags have been removed / ‫وا ﺎدة ا ﻮﻗ ا ﻲ ﺣﺎ ﮫ ا ﻄﺒ ﺔ وﻓﻲ ﺣﺎ ﺔ ا ﺔ‬ ‫ا‬ ‫اﻻ ﮭﺎء‬

Permit Requestor / ‫ﺗﺻﺭ‬ ‫ﻁ‬: …………………………………………Sign. / ‫ا ﻮﻗ‬:…………………………….....Date/ ‫ا ﺎر ﺦ‬: ………………….Time / : …………

Contractor Repair Report Attached YES / ‫ﻧ‬ NO / ‫ﻻ‬
PGESCo WP Completed / ‫ﻣﻝ‬ ‫ﻻﻧﺗ ء ﻣﻥ ﺩ ء‬ PGESCo WP Closed / ‫ﻣﻝ‬ ‫ﻧ ء ﺗﺻﺭ‬
Comm &SU Mech. Elect. I&C Const. Civil. PGESCo Operations:
Name / ‫ﻻﺳ‬ Name / ‫ﻻﺳ‬
Signature / ‫ﺗ‬ Signature / ‫ﺗ‬
Date / ‫ﺗﺭ‬: Time / Date / ‫ﺗﺭ‬: Time /