ADANI POWER LTD

WORK APPROVAL (PTW)

(A) To be filled and ensured by Initiator

UNIT: Stage-1 Common DATE: 28.02.2024
Work Approval (PTW) No: 100003353820 TIME: 11:13:04
Maintenance Order No: 70000666339 Work Centre: C&I-BOP MAINT
Plant: APL-RAIGARH-OPERATIONS Priority: Normal Priority
Valid From: 28.02.2024 11:00:58 Valid To: 29.02.2024 18:00:00
F. L. Code: P591-STCOM-RWS-PMP-002 F. L. Description: RAW WATER PUMP 2
Equipment Code: 3000153983 Equipment Description: RWP-2 MTR GUIDE BRG. TEMP.1 DE RTD
Job Description: RWPH Pump 2 TB replacement

INITIATOR'S CHECKLIST

Is Power cable required to be removed? No Is activity wise Risk Assessment & its mitigation Yes

Is Instrument connection is required to be removed? No along with SOP/SMP/JSA Briefed to each workman?

Is decoupling of motor required? No PPE Provided as identified SOP / SMP / JSA and Risk Yes

Assessment?

Special Permit attached Excavation Work No Floor Opening / Rail Removal Permit No

Hot Work Permit No Permit

Confined Space Entry Permit No Under Water No

Working at Height Permit No Work Permit

Note: Please refer the Graphical Representation of Isolation at the end.

(A) To be filled and ensured by Initiator (C) Authorize Isolator

Energy type Lockout location Lockout Procedure And/Or Technical ID Tagging Untagging Tag No LOTO Key No Name of
and Source Energy Release condition condition Box No Auth. Isolator

(B) Comment By Area Owner

Additional Points to be checked
SN Points to be Checked Yes / No
1
2
Special Comment:

Work Approval (PTW) No: 100003353820

(D) To be filled and ensured by Issuer
Issuer Checklist
(1) Are Plant / Equipment stopped? NA
(2) Are Proceeding & following equipment also stopped? NA
(3) All Mechanical Isolation Done? NA
Have Equipment / Pipelines depressurized (Vent Open) process material emptied out and drain fully? NA
Have the vessel / equipment / line been positively isolated from all sources? (including compressed air, NA
input material, gas entry / exit steam, water, oil and Radiation source if applicable)
(4) All Electrical Isolation Done? NA
(5) All Electrical earthing Done? NA
(6) Are Hazardous energy source locked? NA
All Environmental Test Done? NA
Is the adequate ventilation maintained & equipment reasonably cooled down? NA
(if not, please arrange to provide force ventilation)
(7) Fire-fighting system available? Yes
(8) Scaffolding Checked & Certified? NA

Initiator (Request): PRAVIN KASHYUP Area Owner :RAVI GOME

Initiator (Maint. Acceptance): PRAVIN KASHYUP Issuer :

(E) To be filled by Initiator (F) Permit Holder (Group Leader of Work group)
Noted Clause (D) Work can be started I am briefed and understood clause A, B, C, D. I shall
Date: Time: maintain condition as per checklist.
Name of Initiator: Date: Time:
Signature Name of Permit Holder:
Signature

Renewal of General Work Permit

DATE & TIME INITIATOR ISSUER PERMIT HOLDER
DATE TIME Name Signature Name Signature Name Signature

(G) To be filled by Initiator

The job completed. All men & materials are removed from the site. Site has been cleaned up and it is safe to restore
isolations as stated in clause (C).

Date: Name & Signature of Permit Holder: Name & Signature of Initiator
Time:

(H) Issuer
I have restored isolation for following equipments from list stated in clause (C). Equipment are ready to Start.
Informed to Area Owner

Name & Signature of Issuer: Date & Time

Work Approval (PTW) No: 100003353820