BP Wind Energy Permit No: Permit to Work Permit is not valid for more than 12 hours without reauthorization Request Section Type of Work Requested: Hot Work Cold Work Electrical JSEA completed/attached Additional Permits Required: LOTO Permit # Issue Date/Time Confined Space Permit # 1 Expires Date/Time Ground Dist. Permit # Location BP Contractor Company Name Description of Work Contact 2 Completed by Performing Authority Contact Person/Supervisor Phone Number Equipment Condition Completed by Performing Authority and Verified by Issuing Authority Out of Service In Service Deenergized/Isolated Electrically Energized Other Conditions: 3 Depressured Pressurized Locked out Bleeders open Work Hazards 4 Radio Frequency Atmosphere checked for: Drained Not Drained % Oxygen % LEL CO (carbon monoxide) PPM for: Completed by Performing Authority and Verified by Issuing Authority SIMOPS Oxygen deficiency Pinch points Hot environment Power tools Hydrocarbon vapor Working at heights Cold environment Line of fire Chemical exposure Electrical Heavy lifting High pressure Acids/Caustics Overhead work Falling objects Severe Weather Sources of ignition Eye hazards High noise Mechanical lifting Excavation Hot/Cold surfaces Sharp objects Stored energy Limited access/egress Walking/Working surface Repetitive motion MSDS# Other Hazards: Controls Completed by Issuing and Area Authority Barricades Flagman required LOTO Level 2 Risk Assessment Competent person's name Additional precautions 5 Fire watch Standby fire extinguishers Blanket to contain sparks Use tag line Additional access/egress Tractel Additional lighting Tripod with retrieval device Air mover required GFCI Continuous monitor required, Type See site safety procedures for additional requirements PPE Completed by Performing Authority and Issuing Authority Standard Required PPE: (safety toed boots, hardhat, safety glasses) 6 Rubber boots Face shield/goggles Hearing protection Supplied air Protective suit, Type Respirator, Type Gloves, Type Electrical hot suit, Type FRC 8 cal 20 cal 40 cal Cooling vest Relective vest Lifeline Safety harness/lanyard/ladsafe Any additional PPE Authorization Permit is Not Valid Until Signed Print Sign Performing Authority Issuing Authority 7 Area Authority/Facility Manager Affected Issuing Authority (SIMOPS) Area Authority notified by phone and approves (for after hours work) Date/Time Return Permit to Area Authority when work is finished for the shift Permit Sign Off Completed by BP and Contractor Representative Work Complete 8 Performing Authority Work Incomplete (Please list reasons) Issuing Authority PERMIT IS VOID IF WORK IS NOT STARTED WITHIN 2 HOURS OF GAS TEST Copy of Permit must be at Job Location White-Performing Authority -- Canary-Issuing Authority -- Green-SIMOPS
