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Power Clearance Form

This document is a power clearance form for electrical equipment and installation. It details: 1) The names and departments of those receiving the clearance. 2) The name and details of the equipment being worked on and the declaration that it is electrically safe to work on. 3) The points of earthing, removal of fuses/links, and locks/danger tags provided. 4) The receipt of work acceptance and safety rules to follow. 5) The cancellation certificate once work is complete.

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Brajesh Singh
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1K views2 pages

Power Clearance Form

This document is a power clearance form for electrical equipment and installation. It details: 1) The names and departments of those receiving the clearance. 2) The name and details of the equipment being worked on and the declaration that it is electrically safe to work on. 3) The points of earthing, removal of fuses/links, and locks/danger tags provided. 4) The receipt of work acceptance and safety rules to follow. 5) The cancellation certificate once work is complete.

Uploaded by

Brajesh Singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Form No. : PSD/COM-QM/F04 /00.00 Effective Date: 01.08.

2017

POWER CLEARANCE FOR ELECTRICAL EQUIPMENT / INSTALLATION

1. Issue To :
A. Name…………………………..Dept…………………….SCC No…………………………………
B. Name…………………………..Dept…………………….SCC No…………………………………
C.
2. (A) Name of the Equipment………………………………………………….
(B) Details of Work………………………………………………………………….………….
……………………………………………………………………………..
3. Clearance : I hereby declare that it is electrically safe to work on the above mentioned equipment which
is isolated from all live sources, tested dead discharged and is connected to earth at the following points
(a) Point of Earthings
(b) Related P.T. is drawn out or primary and secondary fuses / links have been taken out
(c) LOCK Number & DANGER TAGs are provided as mentioned below:
Sr.No. Lock Numbers Location

Name :…………………………………Desig………………………….Dept………………….
SCC No……………………..Date…………….Time…………………..Signature ……………

4. Receipt: I hereby declare that I accept responsibility for carrying out the work on the equipment detailed
above and no attempt will be made by me or by the men under my charge to carry out work on any other
equipment. I have read the instructions given on the back of this permit and follow all the safety rules during the
work
A. Name ………………Dept………SCC No…………. B. Name …………Dept………SCC No………….
Date…………….…..Time……….Sign………….… IMPORTANT INSTRUCTION Date…………....Time……….Sign………….…
 Upto 650V – Officers/Foreman/Chargemen with Rule-3 authorization of Indian Electricity rule
5. Cancellation Certificate: I hereby declare that the work for which this clearance was issued is now
1956.
completed / suspended and all man under my charge have been withdrawn. Tools , tackles and temporary
 Upto 6.6KV – Officers / Foreman having valid SSC
earthing connections are all removed. I also declare that this clearance hereby stands cancelled and the job will
 Above
not be started again6.6KV
without– taking
Experienced
a freshofficers with valid SSC
clearance.
A. Name ………………Dept………SCC No…………. B. Name ……………Dept………SCC No………….
1. List of Electrical Safety Items
Date…………….….Time……….Sign………….… Date……………...Time……….Sign………….…
Sl.No.
6. Restoration ofSafety Appliances
Power: / Tools all the
I have checked Uses
copies of this clearance form for cancellation of individual
work01permits issued vide each of the copies. I hereby accept responsibility of restoring power as per restoration
02
procedure and all temporary earthing, Danger tags has been removed and PT if withdrawn put in place. I have
also checked the megger value at the point…………………………………………………………………

Name ………………Dept………SCCIMPORTANT INSTRUCTION


No……………….Date………….Time…………….Sign……………..
Work Permit :
Sl.No. Permit No.(To be given in Permit issued to Agency / Contractor Permit Cancelled By Signature
Form#EHSMSM/JUSCO/446/4001) (Name) (Name)

IMPORTANT INSTRUCTION
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1. Authorisation for Issue, Receipt and Cancellation of this clearance is limited to the person in the
relevant voltage and over & above following hierarchical level as mentioned below :
 Upto 440V – Officers/Foreman/Chargemen with Rule-3 authorization of Indian Electricity rule
1956.
 Upto 6.6KV – Officers / Foreman having valid SSC
 Above 6.6KV – Experienced officers with valid SSC

2. List of Electrical Safety Items

Sl.No. Safety Appliances / Tools Uses


01 COOL COAT (with face shield) During racking in / racking out / lowering /
raising of any HT breaker. During switch
ON/OFF HT breaker from local switch
during power test and discharge
02 LV Jacket with Face shield During LT line operation
03 Electrical insulated hand gloves (EHT, HT & LT rated) For switch operation or connection
04 Power Tester Power test before discharging
05 LT Digital Voltage Tester (Fluk make) For LT line Voltage Test before discharging
06 Discharge Rod For power discharge after power test
07 Electric Safety shoe For all activity to increase body to earth
resistance
08 Insulated torch For light (safe than metallic torch)
09 Helmet For out door working
10 Full body Safety Harness with double lanyard (Safety For working in O/H lines & poles or at a
belt) height more than 2 mts.
11 Grounding & shorting link For grounding & shorting
12 Grounding wire For temporary earthing of equipments.

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