APOLLO TYRE LIMITED

ELECTRICAL DEPARTMENT-LINE CLEARANCE FORM DATE & TIME: PERMISSION LETTER FOR WORKING IN ELECTRICAL EQUIPMENTS.
I Sure that the following from the rest of the distribution line. in this Electrical equipment no load is given and the equipment is separated

PERMIT NO:-

CAUTIONARY board is displayed near the isolation switches/Breakers (I) Comfort for which the Electrical Equipments/Electrical paths to be work is given below

(II) All the isolation switches/Breakers related to that Electrical equipment are isolated and the numbers for the isolation switches/Breakers keys are given below Job Description 1. 2. 3. 4. 5. (III) The location for the proper Earthing of that Electrical Equipments is available or not to be mentioned below 1. 2. 3. 4 (IV) If any other Contractor/persons getting Clearance for working in that same Electrical Equipments, the Contractor/persons details and work details should be mentioned below. 1. 2. WORK INITIATOR Name & Signature Date & Time Designation (If any telephonic or verbal instruction, mention The name of the Work initiator & Designation) WORK CARRIED OUT BY Name & Signature Date & Time Designation (If any telephonic or verbal instruction, mention The name of the Work initiator & Designation) Key no

SHEET 2
Permission Sheet Serial No (If any telephonic or verbal instruction, mention The name of the Work initiator & Designation) Location: Location:

NOTE 1. This line Clearance work permit should be given by the Authorized person to the work carried contractors/person. This Line Clearance permit should be keep with the working person at the time of work. 2. After completing the work the contractors/person should not give the supply to that working Electrical Equipment. 3. COMPLETION OF WORK:The work has been completed and all employees, material and equipment have been withdrawn, Area cleaned. 4. After completion of work, sumbmit this copy to work initiator WORK CARRIED OUT BY Name & Signature Date & Time Designation (If any telephonic or verbal instruction, mention The name of the Work initiator & Designation) THE LINE CLEARENCE WORK PERMIT HAS BEEN CANCELLED. JOB STATUS MENTION:-

WORK INITIATOR Name & Signature: Date & Time Designation (If any telephonic or verbal instruction, mention The name of the Work initiator & Designation)