PTW PART - A

Work Order No. (If any):

16-11906

Date

July 26, 2016 16:41

Name of the PIC :

PIC Contact No.

Vamsinath Vepery

Position

Team Leader- PSS

9652225152

Company

Keolis

No. of Employees Intervening

Location

Description of the Activity :

DT-1 cleaning.

AMS No. (If

any):

16-4055

Start Date

July 28, 2016

Time

11:00

End Date

July 28, 2016

Time

19:30

Corridor 1

Entry Point

Exit Point

Specific Location

JNT

JNT

ASS Room

PTW Type
Power Block

Track Possession

Power Block and Track Possession

No Power Block and No Track Possession

Work Type
Use of Crane

Hot Work

Passenger Safety

Work At Height

Excavation

Work in Confined Space

Vehicle or Trolley Movement

Work in Explosive Environment

Nature Of Work
Inspection

Testing

Installation

Others ________________________________

Disable Fire Detection Req. :

Maintenance

No

Power Block

From

Specific Safety Precaution Required/

Imposed :

Use necessary ppe and earth rod. keep away from live parts.

Specific Consequences on Operation :

No impact, only one system will be under shut down. alternate power supply will be available.

Name of the Requester

Arun Kumar Meti

Approved By Planning

To

Signature

Yes

Name & Signature

Planning Officer

Yes

Name & Signature

Gurpreet Singh

Yes

Name & Signature

Chief Controller

Remarks:
Approved By Safety
Remarks:
Approved By OCC
Remarks:

PTW NO:

16-4055

SAF_FOR_009_R02_S_Permit to Work Form - Part A

QHE_FOR_033

Page

Safety Instructions
General Instructions
SOPs shall be strictly followed by Field Staff and OCC Staff

When leaving intervention area, PTW shall be handed to SC or DC for record

PTW form shall be collated by both parties

Specific Instructions for Works
Before start of the works, Person In Charge (taking the PTW) shall certify that:

A/ Each member of work team is wearing prescribed PPEs for execution of work;
B/ Work site protection is done as per the procedure
C/ Each member has been briefed about the risks involved in the work and understand the same
D/ Contractors staff is having proper Identity proof and are briefed about the work to be done
E/ All members of work team have been informed about the Live OHE
F/ Discharger rods have been provided to earth the OHE after power block;
G/ It has been briefed to all members that Vehicle/ Train movement is also planned in adjacent line/ station
and look out man has been placed to warn, in case of eventuality
H/ All equipment, tools and other items required for execution of work are tested and found in proper working order
I/ No member shall leave or go beyond the Engineers Possession area
J/ Fill Tool Box talk as per prescribed format (QHE_FOR_33) and submit to divisional manager at end of PTW.
Certification by PIC
At the end of the works, Person In Charge (taking PTW) shall certify that:

A/ All men, material, equipment and tools used in execution of work have been removed from the site
B/ All removed equipment have also been secured in proper place away from work place;
C/ Discharger rods have been removed from the site;
D/ The work site is safe for normal operation (provide details if not);
E/ PTW issued to me for execution of work has been closed.

SAF_FOR_009_R02_S_Permit to Work Form - Part A

Page