Fleet Management Limited ON BOARD HOT WORK PERMIT To be filled prior to any "Hot Work" in spaces other than safe area, such as workshops.Before completing this form refer to Section 10 of Company's Health & Safety Manual and notes at end of this checklist. - ONLY ONE HOTWORK PERMIT SHOULD BE ISSUED AT A TIME - A SEPARATE PERMIT SHOULD BE ISSUED/APPROVED FOR EACH INTENDED TASK AND LOCATION - WORK SHALL NOT BE TAKEN UP IF ANSWER IS "NO" TO ANY QUESTION IN SECTION A & B WITHOUT PRIOR APPROVAL OF HEAD OFFICE MV/MT ______________________________________ Date ______________________________________ Sea/Port/Anchor ______________________________ * Ship Ref: _________________________________________ (* - For vessels with operational PARIS 9 or higher) Type of cargo _______________________________________ Cargo/Ballast _________________________________ Reason for work_____________________________________________________________________________________ Location of work ___________________________________________________________________________________ This permit is valid : From ___________hrs Date______________ To ___________hrs Date_______________ ( Validity of this permit should not exceed 12 hours) Has an enclosed space entry permit been issued ? YES / NO Reason if 'NO' _____________________________________________________________________________________ Personnel carrying out hotwork _______________________________________________________________________ Personnel responsible for hotwork _____________________________________________________________________ Person responsible for safety _________________________________________________________________________ A) Check list prior commencement of hot work 1) Has work plan meeting been held and risk assessment completed ? 2) Is the area clean and clear of oil and other dangerous material ? Radius of area to be cleaned (if applicable) : ___________________________________ 3) Adjacent area/compartment cleaned, gas free, inert or filled with water ? 4) Has the hotwork area been checked with a Combustible Gas Detector for hydrocarbon vapours & found less than 1% L.F.L. ? 5) Is adjacent fuel oil bunker tank checked with a Combustible Gas Detector for hydrocarbon vapours & found less than 1% L.F.L. ? 6) Is it confirmed that hotwork will not cause heat transfer throughout the bulkhead of bunker tank ? 7) Oxygen content in compartment is 21% ? 8) Are vapour lines blanked or isolated to area concerned ? 9) Is ventilation to area adequate and continuous ? 10) Has the equipment or pipeline been gas freed ? 11) Has the equipment or pipeline been blanked ? 12) Is the equipment or pipeline free of liquid ? 13) Is equipment to be used in good order and men wearing suitable PPE ? 14) Are fire fighting/life saving appliances in good order and ready for use ? 15) Is the safety organisation and communication plan discussed with all concerned ? 16) Is the Hot Work area more than 500 mm from fuel oil tank deck or bulkhead ? 17) Has approval been obtained from Head Office ? 18) If vessel is in port, has written approval been obtained from port authorities ? B) Additional Checks to be carried out by Tankers 1) Has cargo tank atmosphere checks carried out and entry permit issued ? 2) Has cargo tank washed & gas freed ? 3) If Hot Work required outside tank, is cargo tank purged and inerted to not more than 8% O2 and not more than 2% HC ? 4) Is Hot Work area more than 500 mm from tank deck or bulkhead ? 5) Are applicable cargo tank valves isolated ? 6) All cargo tank within 30 mtrs of the work location, including diagonally positioned cargo tanks, cleaned and gas freed to hot work standard or completely filled with water ? Yes No N/A Fleet Management Limited ON BOARD HOT WORK PERMIT 7) All slops removed from ship or securely isolated in the tank furthest (and at least 30 mtrs) from hot work location ? 8) Vapours or vent lines to the compartment should be ventilated to not more than 1% LFL and isolated ? Special conditions / Precautions (if any) _____________________________________________________________ C) Repeat Checks of Atmosphere Condition Time % LFL Oxygen Sign Person in Carrying out Hot Work I am satisfied that all precautions have been taken and all safety arrangements will be maintained for entire duration of work. Signature Rank Date Time Person in Charge of Hotwork Team I am satisfied that all precautions have been taken and all safety arrangements will be maintained for entire duration of work. Signature Approval by Master Rank Date Time I am satisfied with safety precautions and hereby give my permission to commence work. Signature Date Time D. On completion of Hotwork The work has been completed, equipment secured, permit closed and Company has been informed. Master ________________ Time _______________ Date ___________________ THIS PERMIT IS RENDERED INVALID SHOULD ANY OF THE CONDITIONS NOTED IN THE CHECKLIST CHANGE Notes: This form is to be filled on all vessels when carrying out hot work involving high temperatures, electric arc, open flame or continuous source of sparks. This work includes but is not limited to welding, burning and grinding. REV 4 Apr-10 DE-23B