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PTW Form - A During Interim Phase

This document is a permit to work (PTW) form for maintenance and inspection activities during an interim phase at a railway location. It provides details of the planned work such as dates, times, entry/exit points, type of work, safety precautions, and approvals from planning, safety, and operations control center teams. Key information includes that a name person in charge will oversee no more than a certain number of employees performing activities like crane use, hot work, work at height or in confined spaces between specified start and end dates while ensuring all staff follow safety procedures and wear protective equipment.

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subhashkpn86
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23 views

PTW Form - A During Interim Phase

This document is a permit to work (PTW) form for maintenance and inspection activities during an interim phase at a railway location. It provides details of the planned work such as dates, times, entry/exit points, type of work, safety precautions, and approvals from planning, safety, and operations control center teams. Key information includes that a name person in charge will oversee no more than a certain number of employees performing activities like crane use, hot work, work at height or in confined spaces between specified start and end dates while ensuring all staff follow safety procedures and wear protective equipment.

Uploaded by

subhashkpn86
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
You are on page 1/ 6

PTW form-A during Interim Phase

Work Order No (If any) :

AMS No (If any) :

Date

Name of the PIC :

Position

PIC Contact No

Company

No of Employees Intervening

Location

Description of the Activity : (Write specific work activity that needs to be performd at that location)

Start Date

Start Time

Entry Point

End Date

End Time

Exit Location

PTW type (Note: Only one check box to be checked i.e all the works mentioned on above dates should fall in same PTW
Power Block

Track Possession

Power block and Track Possession

No Power block and No Track Poss

Work type
Use of Crane

Passenger Safety

Hot Work

Work At Height

Excavation

Work in confined Space

Vehicle or Trolley Movement


Nature Of Work
Inspection

Work in Explosive Enviro

Maintenan

Testing

Others ______________________
Disable Installation
Fire Detection
Req. :
Yes No
Power Block
From
Specific Safety Precaution Required/Imposed : (To be imposed by PIC)

To

Specific Consequences on Operation : (To be clearly mentioned by PIC)


Signature

Name of the Requester


Approved By Planning

Y/N

Name & Signature

Y/N

Name & Signature

Remarks:
Approved By Safety

SAF_FOR_004_R01_S_PTW form-A during Interim Phase

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Remarks:
Approved By OCC

Y/N

Name & Signature

Remarks:

PTW NO:

SAF_FOR_004_R01_S_PTW form-A during Interim Phase

QHE_FOR_033

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Safety Instructions

General Instructions
SOPs shall be strickly 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 sam
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 l
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 presecribed format (QHE_FOR_33) and submit to divisional manager at
Certification by PIC
At the end of the works, Person In Charge (taking PTW) shall certify that:

A/
B/
C/
D/
E/

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

SAF_FOR_004_R01_S_PTW form-A during Interim Phase

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Phase
/

Depot Name

Line/Corridor Number

cation)

Specific Location

uld fall in same PTW type category)

d No Track Possession

onfined Space

xplosive Environment
Maintenance

Signature

SAF_FOR_004_R01_S_PTW form-A during Interim Phase

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SAF_FOR_004_R01_S_PTW form-A during Interim Phase

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nderstand the same


e work to be done

anned in adjacent line/ station

ted and found in

sional manager at end of PTW.

n removed from the site


work place;

SAF_FOR_004_R01_S_PTW form-A during Interim Phase

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