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EFT TPP Stanari Work Permit

Turbine Boiler Electrical I&C BoP Coal handling Hot work

Work permit No. ______________________

1. Equipment name and KKS:


___________________________________________________________________________________________________________________________
2. Work content and scope :____________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
3. Work responsible person: _______________________________________________________ /signature /date/time
Members of work team: _____________________________________________________________________________________________________________ Total ____ persons.
Apply scheduled time from: ____________________________________ to ______________________________________ /date/time
4. Approve scheduled time from: ____________________________________ to ______________________________________ /date/time
DEC Shift leader: ________________________________________ /signature EFT Shift leader: _______________________________________ /signature
5. Measures for safe work:
Mechanical:_______________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
Electrical:_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
I&C:______________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
Hot work content (if necessary): ______________________________________________________________________________________________________________________
Measures for hot work: ______________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
If there is work in primary hot work area, it should be approved by senior managers.
DEC Senior managers: _____________________________ /signature /date/time EFT Senior managers: _____________________________ /signature /date/time
6. Measures reviewed by work permit issuer: ___________________________ date ___________ time ______________
7. Measures and operations completed, with No Operation tags placed
Mechanical: ___________________________________________________________________________ Done by _______________________ /signature /date/time
Electrical: _____________________________________________________________________________ Done by _______________________ /signature /date/time
I&C: __________________________________________________________________________________ Done by _______________________ /signature /date/time
Hot work (if necessary): __________________________________________________________________ Done by _______________________ /signature /date/time
Additional measures (if necessary): ____________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
Done by _______________________ /signature /date/time
8. All necessary safety measures above (including supplementary part) have been properly executed and confirmed by work approver as well as work responsible person
on site. The work is permitted to start from ___________________________ /date/time.
Work approver: _________________ /signature EFT shift leader: ___________________ /signature Work responsible person: __________________ /signature
9. Extending work time to __________________________ /date/time (if necessary)
DEC shift leader: _________________ /signature EFT shift leader: ___________________ /signature Work responsible person: __________________ /signature
10. Work finished, tools and workers removed from the site, and the site has been cleaned. All work is finished at __________________________ /date/time.
Work responsible person: _________________________ /signature Work approver: ____________________________ /signature
11. Measures from item No.5 set in original (working) condition and No operation tags removed:
Mechanical: Done by _____________________________ /signature /date/time
Electrical: Done by _____________________________ /signature /date/time
I&C: Done by _____________________________ /signature /date/time
12. Reviewed and closed: DEC Shift leader: ________________________________ /signature EFT shift leader: ________________________________ /signature

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