L&T CONSTRUCTION

POWER TRANSMISSION & DISTRIBUTION IC

Issue
Ref: 2-Rev
IM- 8.1.2.3-H 00
SHUT DOWN CLEARANCE (HT / LT) CUM WORK PERMIT FOR TRANSMISSION LINE,
APDRP / RURAL ELECTRIFICATION AND OTHER WORKS
Date:
To: _____________________________________________ of M/s. Larsen & Toubro Limited.

LC Requested for the purpose of _______________________________________________________________

Sub Division: Unit /O & M/Sub-station:
Feeder: PTP Reference:
LC Required (Location): From: (Location): To:
(Time): From: (Time) To:
Declaration:
I have studied the PTP No.______________ and work area and understand the work area limits, as mentioned in PTP. I
have all the necessary PPE with me for entire work force. I hold responsibility for any sort of violation of PTP limits as well
as work permit. Hence request you to offer LC/Work permit.

SIGNATURE OF FRONTLINE SUPERVISOR SIGNATURE OF SUBCONTRACTOR SUPERVISOR

(Before starting the job)
Date/Time:

Permit validation:
We hereby authorize the above electrical personnel to isolate the above equipment / HT Circuit / LT Circuit from all
sources of power and hand over the equipment / HT Circuit / LT Circuit for maintenance / repair / tapping, after
verification of Safety Precautions as listed below.
SAFETY PRECAUTIONS FOR CLEARENCE NORMALISING AFTER CANCELLING PERMIT
Not Not
Points Done Points Done
Reqd. Reqd.
1. Earthing tuck/ Earting rod/ Discharge Rod
1. Danger tags fixed
removed from each phases and neutral
2. Jumpering of section at both the end placed /
2. Isolator/Breaker switched Off
joined and shorting removed
3. Transformers isolated from both ends 3.Aux. Supply Fuses put/Switched on
4. Fuses removed / Circuit Breaker withdrawn 4. Space heater fuses put/ Switched on
5. Space heater fuses removed 5.Circuit Breaker inserted and Fuses put back
6. Aux. supply switched off/ Fuses removed 6. Transformers are connected at both ends
7. Jumpering of section at both the end removed
7. Isolator/ Breaker switched on
and shorting of conductors done
8. Equipment earthed/ Earthing tuck inserted/
Earthing rod / Discharge Rod put in each phases 8. Danger tags removed
and neutral
9. Other Misc. Jobs detail _____________________________________ 9. Other Misc. Jobs normalized details __________________________
___________________________________________________________ ____________________________________________________________
I Certify that the equipment / circuit mentioned above is isolated from I hereby declare that the above checks have been made and the
all sources of power and is safe to start the work conditions were normalized.
Tag No. Tag No.
SIGNATURE________________ ______________________ SIGNATURE_________________ ______________________

Name:- Name:-
(State Electricity Board/ ) (L&T Site Engineer) (State Electricity Board / ) (L&T Site Engineer)
Permit giving Authority Permit giving Authority
Date & Time :- Date & Time :-
PERMIT VALIDATION FOR DE-ISOLATION

I HEREBY AUTHORISE THE L&T (ELECTRICIAN) TO DE-ISOLATE THE ABOVE EQUIPMENT AND RETURN BACK FOR NORMAL
OPERATION

SIGNATURE __________________ NAME ________________________DATE ________________________

ISSUING AUTHORITY (STATE ELECTRICITY BOARD)

I CERTIFY THAT THE EQUIPMENT MENTIONED ABOVE IS DE-ISOLATED AND IS READY FOR NORMAL OPERATION.

SIGNATURE _______________ NAME _________________________ DATE __________________________

L&T SITE ENGINEER

Sensitivity: LNT Construction Internal Use