White Nile (5B) Petroleum Operating Company Ltd
Permit To Work
Procedure
WNPOC/LII/HSE/019
Main Contents
Page No
Document – New /Amendment Request (DNAR)
i
Document Change History (DCH)
ii
Distribution
iii
1.0
Purpose
1
2.0
Scope
1
3.0
References
1
4.0
Abbreviations
1
5.0
Definitions
2
6.0
Responsibilities
3
7.0
Types of Permit and Usage
5
8.0
Communication
6
8.1
Display Board
6
8.2
PTW Site Log
6
8.3
Pre-job Discussion
6
9.0
10.0
Procedure Details
7
9.1
Job Preparation
7
9.2
Job Execution
7
9.3
Job Completion
7
Auditing
Appendices
•
Confined Space Entry Permit
•
Excavation Permit
•
Cold Work Permit
•
Lifting Permit
•
Electrical Permit
•
Electrical Isolation Permit
•
Hot Work Permit
•
Radiation Permit
•
Safety System Bypass Permit
8
White Nile (5B) Petroleum
Operating Company Ltd.
Document – New /
Amendment Request (DNAR)
DNAR No.
WNPOC/DNAR/HSE/LII/0019
DNAR Date
PAGE NUMBER:
i
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
31.03.06
Status of Document:
New
Revised
Cancellation
Reasons of Changes:
New procedure establishment
Details of Changes
PART WAS
Page No
Para/Clause
Description
None
CHANGE TO
Page No
Para/Clause
Description
New document
QA Check
Initial
Date
Prepared by
Reviewed by
Approved by
Section Head, HSE
HSE Manager
V.PRESIDENT
PERMIT TO WORK
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
REVISION NUMBER:
0
White Nile (5B) Petroleum
Operating Company Ltd.
Document – Change history
(DCH)
Revision
No
0
Status of Change
(New / Revised / Cancellation)
Effective /
Revision
Date
New procedure establishment
31/03/06
PERMIT TO WORK
PAGE NUMBER:
ii
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
Details refer to Document New /
Amendment Request (DNAR)
Prepared
Reviewed
Approved by
by
by
Section
Head,
HSE
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
HSE
Mgr.
V. President
REVISION NUMBER:
0
White Nile (5b) Petroleum
Operating Company Ltd.
Distribution
Copy No
PAGE NUMBER:
iii
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
Position Title
1
President, WNPOC
2
Vice President, WNPOC
3
GM, Exploration & Development
4
GM, Finance & Planning
5
GM, Human Resource & Admin
6
GM, Production
7
Sr. Manager, Exploration
8
Sr. Manager, Operations
9
Sr. Manager, Surface Development
10
Manager, HSE
11
Manager, Corporate Affair & Community Development
12
Manager, Security
13
Superintendent, Base Camp
14
Company Man, Drilling Rig
15
Company Man, Service Rig
16
HSE Supervisor, Block 5A
17
HSE Supervisor, Block 5B
18
HSE Supervisor, Block 8
19
HSE Department
20
Exploration Department
21
Drilling Department
22
Finance & Account Department
23
Human Resource & Admin Department
24
Contract, Procurement & Logistic Department
25
26
PERMIT TO WORK
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
REVISION NUMBER:
0
White Nile (5B) Petroleum
Operating Company
Preliminary
1.0
PAGE NUMBER:
1
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
Purpose
The purpose of the Permit To Work (PTW) procedure is to ensure that there is a formalized
process in place to authorize and control hazardous work by ensuring that adequate
precautions have been taken to safeguard people, property and the environment when the
work is being carried out. It is also to ensure that an effective means of communication has
been established about the hazardous nature of work to the supervisors, those who are
carrying out the work and to those who are working around the hazardous work area.
Although the PTW itself does not make the job safe, it ensures proper consideration is given
to the risks prior to commencement of work. The PTW serves as a record of the
authorization and completion of specific work.
2.0
Scope
The procedure shall be applicable to:
•
•
•
•
All non-routine work that are classified as potentially hazardous or carried out in a
hazardous area;
Routine work that have been categorised by the line department management as
potentially hazardous;
All WNPOC employees and contractor employees working at operational locations;
All WNPOC employees and contractor employees working at premises under WNPOC
prevailing influences.
3.0
•
•
•
•
References
HSE UK publication titled “ Permit-To-Work Systems” -ISBN 0 7176 1331 3.
Industrial Accident Prevention Association of Canada publication on Work Permits.
Alberta, Canada Workplace Health and Safety Bulletin SH –013 on Safe Work Permits.
PETRONAS PTS 60.049 rev.2
4.0
Abbreviations
AA
Approving Authority
PTW
Permit To Work
PA
Permit Applicant
AEP/ SAEP
Authorised Electrical Person / Senior Authorised Electrical Person
PPE
Personal Protective Equipment
AGT
Authorised Gas Tester
LEL
Lower Explosive Limit
PEL
Permissible Exposure Limit
JSA
Job Safety Analysis
H2S
Hydrogen Sulphide
PIC
Person In Charge
ALARP
As Low As Reasonably Practicable
PERMIT TO WORK
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
REVISION NUMBER:
0
White Nile (5B) Petroleum
Operating Company
Definitions
5.0
PAGE NUMBER:
2
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
Definitions
Permit To Work
A formal written system that authorizes specific work, at a specific
work location, for a specific time period. It is used to control and
coordinate potentially hazardous work by ensuring that all
foreseeable hazards have been considered and appropriate
precautions have been defined.
Permit Applicant
The person who applies for the permit e.g. the foreman/
supervisor responsible for planning and execution of the work.
Approving
Authority
The WNPOC Person In-charge at the worksite who is authorised by
management to sign the Permit To Work.
The WNPOC Person In-charge is one of the following: - Field
Production Manager, Production Superintendent, Operations
Superintendent, Field Base Superintendent, Construction
Supervisor, Drilling Supervisor, Facility Supervisor.
In remote areas / facilities the Person In-charge may be delegated
to following: - Production Supervisor, Maintenance Supervisor or
Field Supervisor.
Authorised Gas
Tester
A person, who is qualified, authorized and designated to test the
function of approved gas test equipment and to test worksite and
confined spaces for gas and oxygen levels.
Non-Routine Work
Work that is outside the regular operation of an operating facility.
In this respect maintenance and construction activities are
considered as non-routine.
Authorised
Electrical Person
A competent person who has been trained and authorised by
management to manage the operation, switching and isolation of
electrical switchgear and systems except for HV & EHV.
Senior Authorised
Electrical Person
A competent person who has been trained and authorised by
management to manage the operation, switching and isolation of
HV / EHV electrical switchgear and systems.
Worksite
Preparations /
Precautions
A list of control measures at the place of work execution to be
taken before and during the work covered by the PTW.
Personal
Protective
Equipment
Equipment that has to be worn by individuals to protect
themselves against exposure to hazards while carrying out their
work.
Revalidation
This applies to permits that have to be renewed daily for the
certain jobs that take more than 1 day to complete. Revalidation is
the process of checking that the precautions are still intact and the
approving authority is satisfied that the job can be done safely.
PERMIT TO WORK
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
REVISION NUMBER:
0
White Nile (5B) Petroleum
Operating Company
Responsibilities
6.0
PAGE NUMBER:
3
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
Responsibilities
It is the responsibility of each WNPOC employee and contractor to ensure that an
appropriate PTW has been issued for any non-routine and / or hazardous activity
undertaken.
Permit Applicant
•
•
•
•
•
•
•
•
•
•
•
•
Approving Authority
•
•
•
•
•
•
•
•
•
PERMIT TO WORK
Understand the hazards associated with the particular
activity for which the PTW has been applied;
Determine the correct people, PPE, tools, equipment and
precautions that have to be in place for the job to be
carried out safely;
Prepare a JSA if required for the job;
Fill in the appropriate PTW form stating all the precautions
taken;
Ensure that appropriate warning signs and barricades have
been installed around the worksite;
Visit the worksite with the AA to inspect the precautions
that have been put in place;
Ensure the PTW is approved by the AA before starting
work;
Brief the workers on the requirements of the PTW and JSA
(if applicable);
Ensure Copy no. 1 of the PTW is always kept at the
worksite;
Ensure that the workers adhere to all the PTW
requirements throughout the period the work is being
executed;
Ensures that the PTW is revalidated daily when the job
extends over the specified period; and
Returns copy of the PTW on job completion or cancellation
and informs the appropriate parties concerned.
Ensure all hazards associated with the proposed job have
been identified, assessed and controlled to ALARP;
Ensure the work being authorised does not jeopardise other
activities or ongoing operations of the facility;
To inform the PA on all the nearby activities especially
those that might interfere with his own activity;
Check that all the necessary safety precautions have been
identified in the PTW;
Specifies other PTW that is additionally required for the
job;
Ensure that permits are cross referenced with other
permits;
Assign AGT and other required competent persons as
required;
Revalidate PTW as required; and
Receive PTW on job completion or cancellation
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
REVISION NUMBER:
0
White Nile (5B) Petroleum
Operating Company
Responsibilities
Area Supervisor
•
•
•
•
Authorised Gas Tester
•
•
•
•
Workers performing
the work
•
•
•
•
•
•
•
•
HSE Executive
•
•
•
•
PERMIT TO WORK
PAGE NUMBER:
4
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
Review that the necessary precautions have been filled the
PTW by the applicant
Go to the site to ensure that the safety precautions for the
job have been implemented by the PA
Visit the site the site to ensure the precautions are in place
before requesting the AA to approve the PTW;
Ensure that the PA has briefed all the workers on the PTW
requirements;
Ensure that the Gas Testing equipment is calibrated before
use;
Test for the level of Oxygen, combustible and toxic gases in
confined space areas and in areas where hot work is
carried out as specified by the AA in the PTW to determine
whether it is safe to carry out work;
Ensure that continuous gas monitoring is carried out in
confined space areas; and
Issue gas test certificates and attach them to the PTW.
Ensure that they understand the requirements of the PTW;
Be skilled, qualified trained and competent to perform the
work, including the use of any personnel protective
equipment or rescue equipment;
Adhere to the PTW requirements';
Ensure the job is performed in a safe manner;
Be aware of the hazards that could exist and have the
necessary controls in place;
Make equipment and area safe on completion of the task;
Make the work area safe and seek immediate advice if a
doubt or if circumstances or conditions change; and
Ensure that all tags and signs are prominently displayed so
that personnel are aware that the equipment etc. is
isolated / not to be operated.
To assist the PA in reviewing the PTW application;
To assist the PIC/AA in reviewing the effectiveness of the
safety precautions that have been implemented for the job
requiring the PTW;
To regularly monitor the effectiveness of the safety
precautions during the course of the job; and
To visit the site on completion of the job to ensure that
proper housekeeping has been carried out and it is safe to
resume normal operations.
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
REVISION NUMBER:
0
White Nile (5B) Petroleum
Operating Company
Types of Permit
7.0
PAGE NUMBER:
5
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
Types of Permit and Usage
Hot Work
Cold Work
Electrical
Electrical
Isolation
Lifting
Excavation
Confined Space
Entry
Safety System
Bypass
Radiation
•
Work using or generating heat that is sufficient to ignite gases,
vapours, dusts e.g. welding, burning, cutting, riveting, grinding,
drilling;
• Work involving the use of pneumatic hammers and chippers, nonexplosion proof electrical equipment (lights, tools, and heaters),
and internal combustion engines;
• Presence of flammable materials in the equipment being worked
on;
• Presence of combustible materials that burn or give off flammable
vapours when heated;
• Presence of flammable gases in the atmosphere, or gas entering
from an adjacent area, such as sewers that have not been properly
protected.
All other hazardous non routine work that do not fall into other permit
categories
For specific work on electrical equipment and operations in power
systems to be carried out under the direct supervision of an AEP or
CEP
• Electrical power isolation by an AEP or CEP when electrically
connected systems have to be worked for repair or maintenance
work; and
• Confirmation that an AEP and CEP has electrically isolated the
equipment to be worked on and suitable precautions have been
taken to prevent inadvertent re-connection.
• Lifting over unprotected process or wellheads
• Wire sling is not used for overhead crane
• Wind velocity exceeding 30 knots
• Visibility less than 30 meters
• Load path not fully illuminated
• Multiple crane lifts
• Lifts exceeding 8 tones
• Lift inside confined space
• To ensure that excavation can be made without damage to existing
buried facilities such as pipelines, drains and electric cables;
• To confirm that drawings and site has been checked and no
potential damage is possible; and
• Used in conjunction with Confined Space Entry Permit when
trenches or holes greater than 2metres in depth have to excavated
for laying of pipes, cables and drain pipes
•
For entry into tanks, vessels, large diameter pipes and working in
trenches or holes greater than 2metres in depth
• Used in conjunction with other permits
• Covering the work on process or mechanical equipment
• Bypassing or overriding one or more process control, fire or gas
alarm safety systems to prevent inadvertent facility shutdown.
When radioactive sources are used to carry out radiographic
examination of welding joints
PERMIT TO WORK
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
REVISION NUMBER:
0
White Nile (5B) Petroleum
Operating Company
Communication
8.0
PAGE NUMBER:
6
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
Communication
8.1
•
•
8.2
Display Board
The AA’s copy of the PTW shall be displayed on display board located in the
operations control centre or at a central location in a remote area / facility;
The original copy shall be made available at the work site on a temporary display
board so that it can be checked from time to time to ensure that the safety
precautions are being adhered to at all times.
Work Permit site Log
A current and complete record of all permit to work / certificates shall be kept by
each facility. This record will serve as an information source when issuing additional
work permits / certificates. The following shall be logged in the work permit log: • Types of permit to work
• Number Permit to work
• Date and time permit to work was issued
• Specific work location
• Date and time permit to work was closed off
8.3
Pre-job Discussion
Pre-job discussion shall be conducted prior to commencement of any work under a
permit to work. The discussion is intended to ensure all the job crewmembers
understand the content of the permit to work and safe work procedures. Pre-job
discussion shall be documented.
PERMIT TO WORK
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
REVISION NUMBER:
0
White Nile (5B) Petroleum
Operating Company
Procedure Details
9.0
PAGE NUMBER:
7
DOCUMENT NUMBER:
WNPOC/LII/HSE/019
Procedure details
9.1
•
•
•
•
•
•
•
•
9.2
•
•
•
•
•
•
•
•
9.3
•
•
Job Preparation
The permit applicant shall fill up a permit to work form (in triplicate) with details
of the job to be done, specifying the facility, location, equipment, time limits and
tools to be used;
The person in-charge shall specify other relevant permits required for the job
and all relevant operational and additional precautions - isolation methods for
equipment, safety precautions, PPE and other equipment - required for the job.
Adjacent jobs that are carried out simultaneously shall be catered for.
The PIC shall also specify other signatories required to validate the work permit.
When the precautions have been detailed, the permit shall be returned to the
permit applicant to retain until the preparations are complete.
Permit applicant confirms this by signing the permit.
After obtaining the required signatures, the permit applicant shall return the
permit to the approving authority.
The approving authority shall ensure the correctness and completeness of permit
and certificates. When all the actions are complete, the approving authority shall
sign the permit so that the job can be started.
Job Execution
Copy of work permit shall be retained in the office or control room of the facility
and the permit applicant displays original copy at worksite.
Person in-charge may delegate his subordinates to follow the job execution.
He or his subordinate shall regularly check the worksite as the process and
operational parameters / conditions may have changed.
He has the power to stop the work at any time if the conditions have changed or
the persons executing the works are not observing the precautions.
The hand-over from one operational shift to the next shall include a review of all
outstanding permits.
Request for extension shall be done to the person in-charge.
In case of emergency, a new work permit shall be issued for work continuation.
Original permit to work can be used if the alarm happens to be false.
Job Completion
When the job is completed, the permit applicant shall sign off the permit and
return to person in-charge. The person in-charge may delegate site supervisor
on his behalf to sign for work completion and acceptance.
The work permit is evidence, which may be required for claims, due to injury or
compensation. The original shall, therefore be kept for as long as needed under
local law. At a minimum, it shall be kept for 2 years.
PERMIT TO WORK
EFFECTIVE/REVISION DATE:
31 M A R C H 2006
REVISION NUMBER:
0
10.0 Auditing
•
•
•
•
•
•
The purpose of permit to work auditing is to ensure the permit to work system to
function effectively;
The Supervisor or Person In-charge shall inspect the permit to work log, Permit to work
for proper authorization and validation;
Facilities shall be inspected to ensure that all precautionary measures have been taken,
pre-job discussion has been held;
Management personnel may conduct the similar audit to ensure the above were done
correctly;
Audit findings shall be presented to the HSE department for further review;
Any changes to be made if deem necessary are the responsibility of HSE department.
NO: CS 0001
CONFINED SPACE ENTRYPERMIT
SECTION 1 – REQUISITION
Date:
Time:
APPLICANT’S NAME……………………………………
DEPT./CO……………………………….………………………
STAFF NO./ ID NO………………………………….
LOCATION/FACILITY…………………………………………
WORK DESCRIPTION……………………………………………………………………………….…………………………………………..
………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………..
SECTION 2 – CONFINED SPACE TYPE /HAZARDS/ WORK TO BE CONDUCTED
Storage or Process vessel
Gas & Fumes
Blasting & painting
Others……………………
…………………………
Storage tank
Hydrocarbon liquid
Welding & grinding
…………………………
Lube Oil tank
Loose earth walls
Inspection
Trenches
Cleaning
Pipe laying
SECTION 3 – SAFETY PRECAUTIONS TO BE TAKEN WHEN WORKING IN CONFINED SPACE
Gas Test Results
Gas Monitoring
Fire Extinguisher
Isolation by blinds
Oxygen (19.5% to 22%)___
Continuous
Fire Hose standby
Valves isolated
Combustible (<10%LEL)_____
Every ____hrs
Continuous Ventilation
Valves locked open/close
Toxic (<PEL)______
Low Voltage lighting
Space Cleaned
Standby Watch
Rescue equipment at site
Pre job meeting
Others………………….
Name__________
Entry Status Board
Escape route clear
…………………………
Trench shoring
Personnel health check
…………………………
SECTION 4 – PERSONAL PROTECTIVE EQUIPMENT
Mandatory
Others
Welding apron
Respirators
Cotton gloves
H2S meter
Safety Helmet
Welding shields
Dust masks
Leather gloves
Safety Harness
………………
Safety shoes
Face shields
Ear Plugs/ muffs
Chemical gloves
…
Safety glasses
Goggles
SCBA
Rubber gloves
………………
Coveralls
B & P coveralls
First aid kit
Welding Gloves
…
………………
…
SECTION 5 – ASSOCIATED PERMITS / DOCIUMENTS
Electrical Isolation Permit no………..
Excavation Permit no……………….
JSA required
(Y/N)
Electrical Permit no………………….
Lifting Permit no……………………
Drawing no……………….
Physical isolation Permit no…………
Confined Space Entry Permit no………
Others……………………..
Safety Bypass Permit no…………..
Radiation Permit no………..
SECTION 6 – JOINT SITE VISIT BEFORE WORK STARTS / APPROVAL
I have personally checked the area and system to be worked on and am satisfied that work requested can be carried out safely.
PERMIT APPLICANT
AREA SUPERVISOR
APPROVING AUTHORITY
Name………………………………….
Designation…………………………..
Signature……………………………..
Name………………………………….
Designation…………………………..
Signature……………………………..
Name………………………………….
Designation…………………………..
Signature……………………………..
SECTION 7 – REVALIDATION
Date
PERMIT APPLICANT
AREA SUPERVISOR
SECTION 8 – PERMIT RETURN
Work Completed
Housekeeping completed
APPROVING AUTHORITY
Work incomplete due to
……………………………………………
……………………………………………
PERMIT APPLICANT
Name…………………... Date……...
AREA SUPERVISOR
Name…………………. Date………
APPROVING AUTHORITY
Name………………….
Date………
Signature……………….
Signature……………..
Signature……………..
Copy No. 1 – to be kept at site
Time……...
Time ……
Copy No. 2– Permit applicant
Time………
Copy No. 3– Approving Authority
NO: EX 0001
EXCAVATION PERMIT
SECTION 1 – REQUISITION
Date:
Time:
APPLICANT’S NAME…………………………………
DEPT./CO……………………….………………………
STAFF NO./ ID NO………………………………….
LOCATION/FACILITY…………………………………
WORK DESCRIPTION……………………………………………………………………………….……
………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
SECTION 2 – POSSIBLE HAZARDS
Gas & Fumes
Volatile Liquid under Pressure
High Voltage cables
Traffic
Water pipelines
H2S
Additional Precautions to be followed:
………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………….
SECTION 3 – SAFETY PRECAUTIONS /PERSONAL PROTECTIVE EQUIPMENT
Warning signs
Barricades
Beacon Lights
Traffic Guidance
Safety Helmet
Safety Shoes
Gloves
Safety glasses
Where excavation depth is >1.5m
Gas Test
Shoring
Ladders
Standby watch
SECTION 5 – JOINT SITE VISIT BEFORE WORK STARTS / APPROVAL
I have personally checked the area and system to be worked on and am satisfied that work requested can be carried out safely.
PERMIT APPLICANT
REVIEWED BY MECHANICAL
REVIEWED BY ELECTRICAL
SUPERVISOR
SUPERVISOR
Name………………………………
Designation………………………
Signature…………………………
Name………………………………
Designation………………………
Signature…………………………
Name…………………………………
Designation…………………………..
Signature……………………………..
AREA SUPERVISOR
APPROVING AUTHORITY
Name………………………………….
Designation…………………………..
Signature……………………………..
Name………………………………….
Designation…………………………..
Signature……………………………..
SECTION 6 – REVALIDATION
Date
PERMIT APPLICANT
SECTION 7 – PERMIT RETURN
Work Completed
AREA SUPERVISOR
Site Restored
APPROVING AUTHORITY
Work incomplete due to
………………………………………
………………………………………
PERMIT APPLICANT
Name………………
Date……..
AREA SUPERVISOR
Name………………
Date……
APPROVING AUTHORITY
Name………………….
Date………
Signature……………
Signature……………
Signature……………..
Copy No. 1 – to be kept at site
Time…….
Time ……
Copy No. 2– Permit applicant
Time…….
Copy No. 3– Approving Authority
NO: CW 0001
COLD WORK PERMIT
SECTION 1 – REQUISITION
Date:
Time:
APPLICANT’S NAME……………………………………
DEPT./CO……………………………….………………………
STAFF NO./ ID NO………………………………….
LOCATION/FACILITY…………………………………………
WORK DESCRIPTION……………………………………………………………………………….…………………………………………..
…………………………………………………………………………………………………………………
…………………………
…………………………………………………………………………………………………………………………………………..
SECTION 2 – HAZARDS/HAZARDOUS ACTIVITIES
Working at height
Scaffolding
Gas & Fumes
Electrical
Excavation
Liquid under
pressure
Hot Surface
Radiography
Chemical
Dust
Lifting
H2S
SECTION 3 – WORKSITE PREPARATION/PRECAUTIONS
(Y/N)
Isolation by blinds
(Y/N) System depressurised
Pressure Test
Saw/Cold cut
Hand tools
Needle gun
Scaffold safe to use
Others
……………………….
……………………….
……………………….
(Y/N)
Others………………..
Safety system bypassed
(Y/N)
Fire extinguisher at site (Y/N)
………………………..
Valves locked open/close (Y/N)
Area barricaded
(Y/N)
Escape ways clear
(Y/N)
………………………..
System drained/ flushed (Y/N)
Warning signs installed
(Y/N)
Pre job meeting done
(Y/N)
………………………..
Valves isolated
(Y/N)
SECTION 4 – PERSONAL PROTECTIVE EQUIPMENT
Mandatory
Chemical suit
Respirators
Safety Helmet
Chemical boots
Dust masks
Safety shoes
Face shields
Ear Plugs/ muffs
Safety glasses
Goggles
Coveralls
Disposable suit
Cotton gloves
Leather gloves
Chemical gloves
Rubber gloves
SECTION 5 – ASSOCIATED PERMITS / DOCIUMENTS
Excavation Permit no……………….
Electrical Isolation Permit no………..
H2S meter
Safety Harness
Others
JSA required
(Y/N)
………………
…
………………
…
Electrical Permit no………………….
Lifting Permit no……………………
Drawing no……………….
Physical isolation Permit no…………
Confined Space Entry Permit no………
Others……………….
Safety Bypass Permit no…………..
Radiation Permit no………..
SECTION 6 – JOINT SITE VISIT BEFORE WORK STARTS / APPROVAL
I have personally checked the area and system to be worked on and am satisfied that work requested can be carried out safely.
PERMIT APPLICANT
AREA SUPERVISOR
APPROVING AUTHORITY
Name………………………………….
Designation…………………………..
Signature……………………………..
Name………………………………….
Designation…………………………..
Signature……………………………..
Name………………………………….
Designation…………………………..
Signature……………………………..
SECTION 7 – REVALIDATION
Date
PERMIT APPLICANT
AREA SUPERVISOR
SECTION 8 – PERMIT RETURN
Work Completed
PERMIT APPLICANT
Name…………………... Date……...
AREA SUPERVISOR
Name…………………. Date……...
Work incomplete due to
……………………………………………
……………………………………………
APPROVING AUTHORITY
Name………………….
Date……...
Signature……………….
Signature……………..
Signature……………..
Copy No. 1 – to be kept at site
Time ……..
Housekeeping completed
APPROVING AUTHORITY
Time ……
Copy No. 2– Permit applicant
Time ……
Copy No. 3– Approving Authority
NO: LP 0001
LIFTING PERMIT
SECTION 1 – REQUISITION
Date:
APPLICANT’S NAME…………………………………
STAFF NO./ ID NO………………………………….
Time:
DEPT./CO…………………….………………………
LOCATION/FACILITY…………………………………
WORK DESCRIPTION…………………………………………………….…………………………………………..
…………………………………………………………………………………………………………………………………………
SECTION 2 – TYPE OF LIFT
Major Lift (66%-88% of load chart)
Heavy Lift (20tons or more)
Lifts Over/Near live services
SECTION 3 – CRANE INFORMATION
Truck mounted / Crawler Crane
TYPE OF CRANE
BRAND NAME
MODEL
SECTION 5 – ACTIVITY DETAILS
LOCATION OF LIFT
LENGTH OF BOOM
RADIUS
RIGGING WEIGHT
BLOCK
kg JIB
kg
SLINGS/SHACKLES
kg BALL
kg
SPREADER BAR
kg LOAD LINE
kg
UPPER BOOM PT
kg PIN EXTRACTORS
kg
TOTAL RIGGING WEIGHT
CHART CAPACITY AT RADIUS
kg
WEIGHT OF OBJECT TO BE LIFTED
kg
TOTAL WEIGHT (PLUS RIGGING WEIGHT
kg
SAFETY FACTOR OF CRANE
kg
PERCENTAGE OF SAFETY CHART
kg
NUMBER OF PARTS PER LINE
each
RATED CAPACITY PER PART OF LINE
kg
ACTUAL LOAD PER PART LINE
kg
SECTION 4 – APPROVAL
CRANE SUPERVISOR
LIFT SUPERVISOR
APPROVING AUTHORITY
Name………………………………
Signature……………………………
Date……………..
Name………………………………
Signature……………………………
Date……………..
Name………………………………
Signature…………………………
Date……………..
Copy No. 2– Permit applicant
Copy No. 3– Approving Authority
Copy No. 1 – to be kept at site
NO: E 0001
ELECTRICAL PERMIT
SECTION 1 – REQUISITION
Date:
APPLICANT’S NAME……………………………………
Time:
DEPT./CO……………………………….………………………
STAFF NO./ ID NO………………………………….
LOCATION/FACILITY…………………………………………
WORK DESCRIPTION……………………………………………………………………………….…………………………………………..
………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………..
SECTION 2 – HAZARDS/EQUIPMENT
EQUIPMENT TAG NO:
HV
Switchboard
Lighting
Others……………………
…………………………
LV
Cable
Motor
…………………………
Generator
Transformer
Switchgear
SECTION 3 – WORKSITE PREPARATION/PRECAUTIONS
Pre job meeting done
Others………………..
Fire Extinguisher
Equipment & locked
Earthing installed
Fire Blanket
Barricades installed
………………………..
Cable discharged
Insulated tools available
Warning signs installed
………………………..
Fuses withdrawn
Lock out tags installed
SECTION 4 – PERSONAL PROTECTIVE EQUIPMENT
Mandatory
Goggles
Respirators
Safety Helmet
Electrically
Dust masks
Insulated boots
Safety shoes
Ear Plugs/ muffs
Safety glasses
Coveralls
………………………..
Cotton gloves
Leather gloves
Chemical gloves
Rubber gloves
SECTION 5 – ASSOCIATED PERMITS / DOCIUMENTS
Electrical Isolation Certificate no…….
Confined Space Entry Permit no……
Safety Bypass Permit no…………..
Radiation Permit no………..
H2S meter
Safety Harness
Others
JSA required
(Y/N)
………………
………………
………………
……
Drawing no……………….
Others……………………..
SECTION 6 – JOINT SITE VISIT BEFORE WORK STARTS / APPROVAL
I have personally checked the area and system to be worked on and am satisfied that work requested can be carried out safely.
PERMIT APPLICANT
REVIEWED BY AEP/ SAEP
APPROVING AUTHORITY
Name………………………………….
Designation…………………………..
Signature……………………………..
Name………………………………….
Designation…………………………..
Signature……………………………..
Name………………………………….
Designation…………………………..
Signature……………………………..
SECTION 7 – WORK COMPLETION
HOOK UP AFTER COMPLETION
Motor Reinstalled
Generator reinstalled
Cables Connected
Megger/ Continuity Test Completed
Other works completed
Ready to Energise
SECTION 8 – PERMIT RETURN
Work Completed
DE-ISOLATION
Earthing Removed
Locks and tags removed
Barricades and Warning signs removed
Tools removed
Open panels closed up
Housekeeping completed
Work incomplete due to
……………………………………………
……………………………………………
PERMIT APPLICANT
Name…………………... Date……...
AEP/SAEP
Name…………………. Date………
APPROVING AUTHORITY
Name………………….
Date………
Signature……………….
Signature……………..
Signature……………..
Copy No. 1 – to be kept at site
Time……...
Time ……
Copy No. 2– Permit applicant
Time………
Copy No. 3– Approving Authority
ELECTRICAL ISOLATION PERMIT
SECTION 1 – REQUISITION
NO: EI 0001
Date:
Time:
APPLICANT’S NAME……………………………………
DEPT./CO……………………………….……………………
STAFF NO./ ID NO………………………………….
LOCATION………………………………………….
UNIT/AREA/FACILITY:
EQUIPMENT TAG NO:
START DATE:……………………………
START TIME……………………………
CLOSE OUT DATE…………………………………..
CLOSE OUT TIME………………………………
WORK DESCRIPTION……………………………………………………………………………….…………………………………………..
………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………..
SECTION 2 – TYPE OF ISOLATION REQUIRED
Switch Out
Rack out
SWITCHGEAR
SWITCH
BOARD
PANEL
Record at log book
LOCKS
LABEL/DESCRIPTION
A
C
Lock Out Tag Out
NOTICES
DANGER
CAUTION
EARTHED
INITIAL
I herby confirm that the equipment (stated above) has been deenergised, isolated from all electrical sources and safe to work on.
COMPETENT ELECTRICAL PERSON (CEP)
CONFIRMED BY AUTHORISED ELECTRICAL
PERSON (AEP)
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
Name………………………………….
Designation…………………………..
Signature……………………………..
Date…………..
SECTION 3 – OTHER PERMITS ASSOCIATED WITH THIS ISOLATION
PTW NO.
ORIGINATING SECTION
VALIDITY
SECTION 4 – REQUEST FOR DE-ISOLATION
I hereby confirm that the work for which electrical isolation
was required has been completed, personnel withdrawn and
request equipment to be re-energised.
WORK SUPERVISOR
I have checked the work area and confirm that there are no
personnel or tools around the work area and it is safe to reenergise the equipment.
COMPETENT ELECTRICAL PERSON (CEP)
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
SECTION 4 – NORMALISATION
I hereby confirm that the electrical power to the equipment has been normalised and can be used as required.
AUTHORISED ELECTRICAL PERSON (AEP)
Name………………………………
Copy No. 1 – to be kept at site
Signature……………………………
Copy No. 2– Permit applicant
Date……………..
Copy No. 3– Approving Authority
NO: HW 0001
HOT WORK PERMIT
SECTION 1 – REQUISITION
Date:
Time:
APPLICANT’S NAME……………………………………
DEPT./CO……………………………….………………………
STAFF NO./ ID NO………………………………….
LOCATION/FACILITY…………………………………………
WORK DESCRIPTION……………………………………………………………………………….…………………………………………..
………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………..
SECTION 2 – HAZARDS/HAZARDOUS ACTIVITIES
Welding
Blasting & Painting
Spark producing
Others……………………
…………………………
Flame Cutting
Power brushing
Self igniting material
…………………………
Open Flame
Hot Tapping
Gas & Fumes
Grinding
Photography
Hydrocarbon liquid
SECTION 3 – WORKSITE PREPARATION/PRECAUTIONS
Gas Monitoring
Others………………..
Fire Extinguisher
Pre job meeting done
Continuous
Fire Blanket
………………………..
Gas Test Results
Every ____hrs
Fire Retardant Screen
Oxygen (19.5% to 22%) _____
………………………..
Spark Arrestor on Engines
Fire Watch
Combustible (<10%LEL)_____
Cover for drain/ sump
………………………..
Name__________
Toxic (<PEL)______
Fire Hose standby
SECTION 4 – PERSONAL PROTECTIVE EQUIPMENT
Mandatory
Welding apron
Respirators
Safety Helmet
Welding shields
Dust masks
Safety shoes
Face shields
Ear Plugs/ muffs
Safety glasses
Goggles
Coveralls
B & P coveralls
Cotton gloves
Leather gloves
Chemical gloves
Rubber gloves
Welding Gloves
SECTION 5 – ASSOCIATED PERMITS / DOCIUMENTS
Excavation Permit no……………….
Electrical Isolation Permit no………..
H2S meter
Safety Harness
Others
JSA required
(Y/N)
………………
…
………………
…
………………
Electrical Permit no………………….
Lifting Permit no……………………
Drawing no……………….
Physical isolation Permit no…………
Confined Space Entry Permit no………
Others……………………..
Safety Bypass Permit no…………..
Radiation Permit no………..
SECTION 6 – JOINT SITE VISIT BEFORE WORK STARTS / APPROVAL
I have personally checked the area and system to be worked on and am satisfied that work requested can be carried out safely.
PERMIT APPLICANT
AREA SUPERVISOR
APPROVING AUTHORITY
Name………………………………….
Designation…………………………..
Signature……………………………..
Name………………………………….
Designation…………………………..
Signature……………………………..
Name………………………………….
Designation…………………………..
Signature……………………………..
SECTION 7 – REVALIDATION
Date
PERMIT APPLICANT
AREA SUPERVISOR
SECTION 8 – PERMIT RETURN
Work Completed
PERMIT APPLICANT
Name…………………... Date……...
AREA SUPERVISOR
Name…………………. Date………
Work incomplete due to
……………………………………………
……………………………………………
APPROVING AUTHORITY
Name………………….
Date………
Signature……………….
Signature……………..
Signature……………..
Copy No. 1 – to be kept at site
Time……...
Housekeeping completed
APPROVING AUTHORITY
Time ……
Copy No. 2– Permit applicant
Time………
Copy No. 3– Approving Authority
NO: R 0001
RADIATION PERMIT
SECTION 1 – REQUISITION
Date:
Time:
APPLICANT’S NAME……………………………………
DEPT./CO……………………………….……………………
STAFF NO./ ID NO………………………………….
LOCATION………………………………………….
UNIT/AREA/FACILITY:
START DATE:……………………………
CLOSE OUT DATE…………………………………..
START TIME……………………………
CLOSE OUT TIME………………………………
SECTION 2 – WORK DESCRIPTION
WELD SURVEY
CORROSION INSPECTION
ISOLATION/ COMMISSIONING OF SOURCE
SPECIAL INVESTIGATIONS
………………………………………………………………….
………………………………………………………………….
SECTION 4 – RADIACTIVE SOURCE DETAILS
1.
RADIOACTIVE SOURCE: (X-RAY/ISOTOPE)……………………………………………………………..
2.
MAXIMUM ACTIVITY (KV/Ci)………………………………………………………………………………
3.
TYPE OF RADIATION: ( X- RAY / ALPHA /BETA /GAMMA0
SECTION 5 – PRECAUTIONS TO BE TAKEN BEFORE AND DURING ACTIVITY
AREA TO BE BARRICADED
WARNING SIGNS INSTALLED
X-RAY DOSIMETERS USED BY TECHNICIANS
SOURCED STORED IN APPROVED CONTAINER WHEN MOVING TO WORK SITE
SECTION 6 – VERIFICATION BY WNPOC SUPERVISOR
I hereby confirm that the site has been inspected, personnel removed and radiation technicians have taken all the
necessary safety precautions to carry out the activity.
WORKS SUPERVISOR
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
SECTION 7– APPROVAL
I hereby authorise the Radiation activity to be carried out
PERSON IN CHARGE
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
SECTION 8– WORK COMPLETION
I hereby confirm that radiation activity has been completed
and the site has been restored for safe work
ACCEPTED
AREA SUPERVISOR
APPROVING AUTHORITY
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
Copy No. 1 – to be kept at site
Copy No. 2– Permit applicant
Copy No. 3– Approving Authority
NO: SSB 0001
SAFETY SYSTEM BYPASS PERMIT
SECTION 1 – REQUISITION
Date:
Time:
APPLICANT’S NAME……………………………………
DEPT./CO……………………………….……………………
STAFF NO./ ID NO………………………………….
LOCATION………………………………………….
UNIT/AREA/FACILITY:
EQUIPMENT TAG NO:
START DATE:……………………………
CLOSE OUT DATE…………………………………..
START TIME……………………………
CLOSE OUT TIME………………………………
SECTION 2 – WORK DESCRIPTION
REASON FOR SAFETY SYSTEM BYPASS
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
EFFECT ON SYSTEM DURING PERIOD OF BYPASS
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
METHOD OF BYPASS
Physical Isolation
Hardwire jumper
Temporary Setting Change
Temporary Removal of Instrument
Others……………………………………………………………….
SECTION 3 – ADDITIONAL PRECAUTIONS TO BE TAKEN
PRECAUTIONS TO BE TAKEN
Additional Precautions / Instruction
Bypass notification notified to all at site
…………………………………………………………………
Permit copy located in control room
…………………………………………………………………
………………………………………………………………..
I shall implement all precautions as specified before work starts
Name………………………………….
Designation…………………………..
Signature……………………………..
SECTION 4 – APPROVAL
I hereby authorise the applicant to proceed with Safety System Bypass as requested
PERSON IN CHARGE
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
SECTION 5– WORK COMPLETION
I hereby confirm that the work for which Safety System
Bypass was required has been completed and the system is
back to normal operating mode
ACCEPTED
AREA SUPERVISOR
APPROVING AUTHORITY
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
Copy No. 1 – to be kept at site
Name………………………………….
Designation…………………………..
Signature……………………………..
Date………….
Copy No. 2– Permit applicant
Copy No. 3– Approving Authority