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Hot Work Permit Form
Page of
Hot Work Permit
Vessel:
1 HotWork [1 Work on pipelines or pressure vessels
Rear ary werk malin impereurecondions whi re key tobe of scent ensty fo aus gion of conbustle gases
Capon orien ocean invoved
General - Scope of Work
Location of work ENGINE ROOM, PURIFIER DECK
Description of work: WELDING
This permit is valid from: Date:__2101.14 Time: 08.00
to: Date___2101.14 Time: 17.00
Has an enclosed space Entry Permit been issued? OYes LINo
Personnel carrying out work / fire watch: OILER
Person in charge of working team: FITTER
Section 1 — Pre work checks
1.1 Has the Tool Box Talk (including Risk Assessment for the work) been held? OyYes (No
1.2 Work area and adjacent areas has been checked for danger of combustible gas / materials? [] Yes [] No
1.3. Is the equipment or pipeline free of gas? CYes LINo
1.4 Has the equipment or pipeline been purged? (CYes LJNo
1.5 Has the equipment or pipeline been blanked? Ces CINo
1.6 Is the equipment or pipeline free of liquid? OYes LNo
1.7 _Isthe area safe and good ventilated for hot work? OYes No
1.8. Is additional fire protection available? (E.g. fire extinguisher, fire hose; delete not appicebleitem) C] Yes LJ No
1.9 Afire watch has been instructed and set up in adjacent compartments and areas? OYes (No
1.10 Is the equipment electrically isolated? OYes No
1.11 Special conditions or precautions required? Details yes): NONE. Ces T1No
1.12 The following personal protection must be worn:
[a Hard hat helmet) Ba Working clothes (overall) J Leather gauntlets / apron
[Working gloves Oicoggles O visor
1.13 Equipment / Pipeline contained following material in service
1.14 Equipment expected to contain the following hazardous material when opened:
In the circumstances noted itis considered safe to proceed with this work.
Signed upon completion of Section 1 by:
Master or nominated responsible person: Date: 21.01.14 Time:, Signature:
Person carrying out the work: Date: 21.01.14 Time, Signature:
‘Section 2 - Completion of job
(To be completed and signed by the responsible person super
ing the work.)
‘The work has been completed and all persons under my supervision, material and equipment have been
withdrawn.
Job completed: Date: 21.01.14 Time: Signature:
‘Space secured against entry: Date: 21,0114 Time: Signature:
Officer of the watch has been informed: Date: 21,01,14 Time: Signature:
Fire watch completed: 1 vs atertmework Date: 21,01.14 Time: Signature:
This permit is rendered invalid should any of the conditions noted in the checklist change.
