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Code: SQE/Form-P-007


Ver/Rev: 2.00

(Must be used when working on: Electrical motors (220V or higher), GSP, Alternators, MSB, ESB, Power Distribution
Transformers, Radars, Radio Comm. Systems; and any other systems as decided by the Master or Chief Engr.)
Refer to Company Procedure SAF-11)

Vessel:M.T.HIGH WIND Position/Location:      

A) Brief description of work:
B) Persons assigned to work Team leader at work      
Other persons assigned:     
C) Method of Isolation:

(C) Items to check prior carrying out the job Yes/No/NA

1 Have sufficient persons been assigned for the job?      
2 Have the correct procedures for de-energizing the equipment/circuit been advised to the      
workers? (for e.g.: one or more of these- “trip switch”, “remove breaker”, “earth”, “check for
residual charge”, etc.)
3 Has the officer and engineer of watch been informed?      
4 Have the work personnel been issued appropriate gear to protect against electrical shocks? (for      
e.g.: insulated tools, insulated gloves, insulated shoes etc.)
5 Is the work area properly illuminated?      
6 Have static electricity hazards been accounted for while disconnecting parts of      
7 Has it been identified which equipment or process upstream and downstream from the job site      
a) will be effected due to de-energizing of the system?
b) Have adequate measures been taken to maintain safe operations as back-up for such effected      
equipment or process?
8 Has the equipment/circuit been isolated from the system, and “tagged-out / locked-out”?      
9 Has the equipment/circuit been de-energized?      
a) Has the de-energization been confirmed personally by the responsible officer issuing this      
b) permit?
(D) Cross-reference to other work permit –
Check and confirm if the nature of the job requires      
any other work permit to be issued simultaneously. If
yes, list the other permits/ issued:

(E) Permit issued and it is safe to commence work:

Validity: From: Date/time       Till: Date/time      
Elect. Officer: Name/ Sign Chief Eng. : Sign
(F) On Completion of work
1 Have all persons been safely accounted for?      
2 Has all the gear been secured, as it was before the commencement of this job?      
3 Has the duty officer and engineer been notified of the completion of this job?      
4 If any items were immobilized, then have they been reverted to their normal operating      
condition, and the dept. heads informed, as applicable?
Elect. Officer: (Sign) Ch. Eng. : (Sign) Date/Time:

Issued: SQE Dept. Approved: DMR