State Electricity Board, Uttar Pradesh
(Hydro-power unit)
Work permit-form

Number...............................
Time………………………

Power house/ Sub-S tation
Date……………

Application for work

I, ..................................., have got permission for taking further action for the following work and, hereby .................................................. ................... I request that .......................... ................... to make it 'non-live' (cold).

Job description

………………………………………………………………………………………………………………………………………………………….
Signature ................................................. ... Designation .........................

Authorization to perform further proceedings of the work

I, ............................................... hereby inform ........................................... that ........................................., according to instructions given in the Red Book of the safety manual dated ........................ 196  to ................... ............ make it 'non-live' (cold) and 'earth' (earth).

The following switch-related and 'Earth' related functions have been performed:
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................

Signature…………………...
Designation………………….

Date ......................, 196              Office ......................

Declaration of the person in charge of the work

I, .......................... hereby declare that I fully understand the nature of the work to be performed under this work permit  and I have satisfied myself that the section on which work is to be done is 'non-live (cold)' and it has been correctly described in this permit.

Signature .......................
Designation ........................

Certificate for ending the work

I .................................................hereby notify ………………………………. that the work described in this permit has been executed, all persons have left the equipment.

Signature .......................
Designation ........................

Proof of energizing

I, the following signatory, certify that I have reviewed the work that has been done in accordance to this permit, and after testing the device, I am satisfied with the fact that the device is ready to be made live (hot) .

Signature .......................
Designation ........................

Number .................................                                                  Date ..........................

Sent to Sub-divisional officer, ....................... for information and disposal.

Signature .......................
Designation ........................

Number .................................                                                  Date ..........................

Submitted to Executive Engineer ………………………………………

                                                                        Signature ..................
                                                       Sub-divisional officer .......................