eee arr arenas Fahes Oil Corporation Limited Indian, Sohne oe (Functional Loc) : 4341-SEP - S&EP-HUBLI DEPOT. ah Wits TATA Work Permit Request) : 434/C2300207/4341CP23000207 Cold Work Permit - Normal vaie (Plant): 4341 Hubli Depot [Original Copy Fram Desc) : Yearly resting of HMT, Lifting tools / safety harness belt etc as per (Factories Act) ‘ard #1 Wel EI ( Exact Location of work ): TLF,Calibration Tower and other area Work Ciearance from 16:05:29 of 24.11.2023 to 18:30:00 of 24. 11.2023 (Valid for the shift unless renewed) ‘Fear wa fer (Issued to) : Department Order : 280367721 / 10 (rat) (oar Fra Qno ‘Answer Details a” 1 aves EQUIPMENT / WORK AREA INSPECTED 2 arate ar art aa ala, arpa ax oa fear aT at Yes SURROUNDING AREA CHECKED, CLEANED AND COVERED 3 Sree ome we Reno arere we Rea ee Pa a ae Fee ats ae areca aeINA EQUIPMENT BLINDED/DISCONNECTED/CLOSED/ISOLATED/WEDGE OPENED 4 ‘hhrite tt pet ace a Ba athe Heres a fear eT TECH TEENA EQUIPMENT PROPERLY DRAINED AND DEPRESSURIZED 5 ‘Stipe faaga cea (ahtay we wefte ster. Raga tram fear weer ag PNA EQUIPMENT ELECTRICALLY ISOLATED AND TAGGED VIDE PERMIT NO. ‘FracTDetail): NA 6 ‘Siaraite at arth & eae Pare arc 7eINA EQUIPMENT WATER FLUSHED 7 Slip a get ag eft / ok horror ree aeINA EQUIPMENT PROPERLY STEAMED / PURGED 8 wet att gar ar arama ate thar ar era Pear aT efYes PROPER VENTILATION AND LIGHTING PROVIDED 9 aor a Ht Oe fear wear ate araertt aha AVE oat Pear ava BYes AREA CORDONED OFF & CAUTION BOARDS / TAGS PROVIDED. fraTDetail): YES 10 tha tee: eregrarda (% wa $a) eives GAS TEST: HCS (% LEL) 1 eater: Pere fe cfrfteay Bes GAS TEST: TOXIC GAS ( PPM ) " fatter eiga s.ta.n, cited qeen Page) Phar - racine H aT dae aE Bes SET, a aete FE DULY APPROVED JSA (JOB SAFETY ANALYSIS)DONE - MENTION REF NO ISA IN OBSERVATION Pracor(Detail): 43412300329 Fort: (1) weaifitr ard 3 fratetere attire aarfre aat B (Y-yes, N-no) Remarks : (1) The activity has the following expected residual hazards. (Y-yes, N-no) STS WeHTES) NG arth) {AN}. @letor carr) AN} HS Lack of Oxygen Corrosive Chemicals (Fret tay {N} Garret {Y}0) Gia ar: {N} Toxic: Gases Combustible Gases Steam Condensate crredeate areca) AN} aregtorr ter iN} Pyrophorie Iron N2 Gas Other: FALL AND TRIPSfeaa area areata fares Cold Work Permit - Normal Indian Oil Corporation Limited watiz (Plant): 434/ Hubli Depot arfl(Company): 4300 ETT ‘(Functional Loc) : 4341-SEP - S&EP-HUBLI DEPOT. Wiginal Coy ah aftle aqerea(Work Permit Request) : 434102300207/4341CP23000207 faacor(Dese) : Yearly testing of HMT, Lifting tools / safety harness belt etc as per (Factories Act) Following additional PPE to be used in addition to standards PEs. (Y-yes, N-n0) \ (Helmet , Safety Shoes , Hand Gloves , Boiler Suit ) ra aftes). {N} Gea CUT ATER) {N} Face Shield Fresh Air Mask aaa ae) {N} (SRE RTER) Ger) AN} Goggles Dust Respirator Earmuff (ares are) Any eae AN} Life Line Apron ~ (Waa) {N} Airline (3) afte araarft arere 418 Zh : PROPER PPES Additional Precaution (if any) aft npdgiat at coat ate ara B14 are ote A at art at ar she ame ote aed Roms aor aa cette a ate ett at ar ore pen a ere By A ae eae Te aha TE eT AT gare EMT Tool box talk has been given to all the workers. { have read and understood all the conditions of the work permit and do here by undertake to ensure compliance of all conditions as ‘mentioned in the work permit during execution of the work. I will also ensure safe working at the work site. ‘Baer HT ETAT Signature of Congfactor's Supervis: lagae-airs et ar ae 7a hid User-D_ Name Desg. [Date Time jewrdiy 504624 IRavi Meena MGR(OPS- {24.11.2023 15:40:18 Requested By IMM) carrera / eater raret)” 500621 ‘Sanal R. SDM 'D' 24.11.2023 16:05:20 Issued by/Location-in-charge alae.) Sa) jars CISF/DSO/Safety Closing of the Work Permit se [in mon4 Zales |B: 4 Date and Time ‘Name and Designation jignature Issuer % T.& PM (4 ]22--\$t0 Date and Time ‘Name and Designation ignatur | eee ir Pee eee eercarcaiters Ferries Cold Work Permit - Normal il Corporation Limited vale (Plant): 434/ Hubli Depot “ompany): 4300 (Functional Loc) : 4341-SEP - S&EP-HUBLI DEPOT. (Griginal Cop afte arqtter( Work Permit Request) 4341C2300207/4341CP 23000207 \(Dese) : Yearly testing of HMI, Lifting tools / safety harness belt etc as per (Factories Act) Pete water CLEARANCE RENEWALS per (wal ceredrare | (Prieta | cifras | afeter cry a 4% | Toxic Gases %) araarit | Requested By| Issued by (Time To}HC% LEL| (ppm) | Oxygen %! _Aditional Precautions aa al eragian | (addtae |ittaar | afar | ard) |eareeah cr TI% | Toxic Gases %) ‘arauTdt | Requested By| Issued by Time ToHHC% LEL| (ppm) | Oxygen %| _Aditional Precautions “*This is a computer generated document and does not require a signature. EMERGENCY PHONE NOS. FIRE: FIRSTAID: AMBULANCE: