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