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    Work Approval (PTW) : Initiator'S Checklist

    Uploaded by

    Ashish Singh

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Work Approval (PTW) : Initiator'S Checklist

    Uploaded by

    Ashish Singh
    8 views2 pages

    Original Title

    M403713637_1730107318247

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    © All Rights Reserved
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    8 views2 pages

    Work Approval (PTW) : Initiator'S Checklist

    Uploaded by

    Ashish Singh

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    ADANI POWER LTD

    WORK APPROVAL (PTW)

    (A) To be filled and ensured by Initiator


    UNIT: Stage-1 Common DATE: 28.10.2024
    Work Approval (PTW) No: 100003602822 TIME: 14:51:57
    Maintenance Order No: 10001012017 Work Centre: MMD-DM/RO PLANT
    Plant: APL-RAIGARH-OPERATIONS Priority: Normal Priority
    Valid From: 28.10.2024 12:58:12 Valid To: 29.10.2024 17:58:00
    F. L. Code: P591-STCOM-WTP-CLW-PMP-001 F. L. Description: WTP-CLARRIEFIED WATER PUMP 1
    Equipment Code: 1000158378 Equipment Description: PT-CLRIFIR WTR TRSFRT PUMP-1
    Job Description: Clarriefied wtr line pin hole

    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 Yes 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: 100003602822


    (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): ARUN ASATI Area Owner :Satish Dewangan

    Initiator (Maint. Acceptance): ARUN ASATI 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: 100003602822

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