TNB REMACO PAKISTAN

PERMIT TO WORK CERTIFICATE CONTRACTORS (MECHANICAL)

HUBCO COMBINED CYCLE DIESEL 225MW POWER PLANT NAROWAL

Unit No/Plant: ........................................

Serial No

: 0001.......

Work Order No.:....... Key Safe No. ...............

Name of Contractor/ Company : . Name of Contractors Competent Person in charge of the work: (a) Circuit Designation ..................... ..................... ......................

(b) Here describe EXACTLY ......................... the only Apparatus on .............................. which work is to be done ........................... (c) Equipment Electrically Isolated Equipment Mechanically Isolated Safety Locked Rotation Check Necessary Yes / No Yes / No Yes / No Yes / No Required Valves Closed Yes / No Line Blinded / Flushed Yes / No Do Not Operate Tag Fitted (No Yes / No

(d) Precaution to be taken Safety Helmet Yes / No Safety Shoes Yes / No LEP Yes / No Safety Goggle Yes / No PVC Gloves Yes / No Safety Harness Yes / No Face Shield Yes / No Dust Mask Yes / No Respirator/BA sets Yes / No Others (E) Other Precautions Barriers Required Scaffold Inspected

Yes / No Yes / No

Hot / Cold Surfaces Covered Yes / No Others.

We have personally inspected and ensure that all safety checks mentioned above have been made and it is safe to do the above mentioned work.

Issued and signed by : ..

Authorized Person.

Name: .... Date: Time: .

I understand the job, Hazards and precautions necessary to carry out the job. It is my responsibility to act upon in the field. Signed: Contractors Competent Person in Charge of the work Name: . Date: Time: .

Signed : TNBRP representative Name: . Date: Time:

CLEARANCE CERTIFICATE
I hereby declare that work area cleaned and rendered safe for operation. Signed : Contractors Competent Person in charge of the work Name: . Date: Time: . Signed : TNBRP representative Name: . Date: Time: .

CANCELLATION
When the above declaration has been signed and the certificate returned to the Authorised Person the Authorised Person must sign the declarations below and also write CANCELLED across the face of the original and all copies and thus cancel the permit. I hereby certify that the Permit-To- Work Certificate (mechanical) for Contractors and all copies are hereby cancelled. Signature: ..

Authorized Person.

Name: .... Date: Time: . Signed : Contractors Competent Person in charge of the work. Name: . Date: Time: .

Note: Maximum validity for a permit 7 days.