Document No.
: TDBL-HS-B-S-007
Addendum.: I
Type: Form Hot Work Permit
Page: Page 1 of 2
ISSUE SECTION (To be filled by Competent Person)
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Application No (Maximo/AFW) Application Approval Date ...
Is the work carried out under a Limited Access Permit (LAP)?................ LAP#........................................... (Attach copy of LAP to this permit)
Cross Reference List all the Safety Documents linked to this Hot Work Safety Document
1. .
2. .. .
ISSUE SECTION (To be filled by Authorized Person)
Identification of Equipment .
Work Description:
.........................
.
PREVENTIVE MEASURES (Completed by Authorised Person & Verified by Competent Person)
Tick the required and fill additional information.
ADDITIONAL INFORMATION/
MEASURE Y/N
DESCRIPTION OF PREVENTIVE MEASURE
Area cleared of loose combustible materials
Gas Test Performed
Clear Exit Route provided
Open drain covers/ spark guards provided
Wall and floor openings covered
Fire Extinguisher available (9 kg of dry powder minimum) / Fire Blanket available
Fire Detection and suppression systems operational
Pipes/ Vessels/ Containers depressurized, drained and purged with Nitrogen
Non-Sparking tools and explosion proof equipment provided. Applicable for identified explosive atmospheres
Above groundwork is shielded to avoid spark projection to lower levels
Fire watch available
Fire watch trained Please provide training certificate
Fire watch located the nearest fire alarm
Please list PPE required for the activity:
PPE Provided
Other control measures
If you answer No to any of the above, give details of what remedial action you have taken to allow work to proceed:
..............
. ....
Gas Test
Substance Tested Permissible Level Reading Date Time
Oxygen (%) 19.5 to 23.5 %
% of lower explosive limit (LEL) 0
Carbon Monoxide (CO) 0 ppm
Hydrogen Sulfide (H2S) 0 ppm
Other Flammable 0 ppm
I, as Authorized Person, hereby declare that all preventive measures and controls for the hot work activity have been implemented and verified with the
Competent Person.
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RECEIPT SECTION (To be filled by Competent Person)
I, as Competent Person, hereby declare that I have satisfied myself that it is safe to commence work and that I have jointly verified the implementation
of precautions with the Authorised Person and explained the precautions to achieve General Safety to all members of the working party. I further accept
responsibility for carrying out and adequately Supervising the work as detailed above. If any conditions or scope of work changes, then the work shall
be stopped immediately, withdraw your team members and inform the AP.
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Document No.: TDBL-HS-B-S-007
Addendum.: I
Type: Form Hot Work Permit
Page: Page 2 of 2
CLEARANCE SECTION (To be filled by Competent Person)
I, as Competent Person, hereby declare that all men have been withdrawn and warned that it is no longer safe to carry out the work that all tools and
gear have been removed, leaving the Equipment ready for return to service.
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CANCELLATION SECTION (To be filled by Authorized Person)
I, as Authorized Person, have inspected the work covered by this permit and I am satisfied that it is fit for operational service.
THE SAFETY DOCUMENT IS HEREBY CANCELLED
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Has the work extended beyond the safety document validity? Yes No
If Yes, please indicate the new Safety Document number:
Hotline Number:
SUSPENSION SECTION
Conditions:
1. If for any reason the activities covered by the different Safety Documents shall be stopped, the Safety Document can be suspended.
2. Prior to the suspension, the AP and CP shall assess which safety precautions implemented under the Safety Document shall remain active despite the suspension.
3. Based on the above, the suspension section of the Safety Document shall be filled, and the relevant precautions shall remain active based on general site and personnel
safety considerations.
4. When it is required to remove the suspension, the implemented controls shall be re-evaluated to confirm validity. The cancellation of the suspension shall be filled in the
relevant section of the Safety Document.
TRANSFER SECTION
We hereby declare that we have satisfied ourselves that the Equipment stated above is safe to work on and that the Outgoing CP has explained the precautions to achieve
Safety from the System as well as General Safety to the Incoming CP:
1st Transfer 2nd Transfer
Date/Time
Reason for Transfer
Control Person Name
Control Person Certificate #
Outgoing CP Incoming CP Outgoing CP Incoming CP
Name
Certificate #
Valid Certificate
Mobile No.
Signature
Conditions:
1. document.
2. The outgoing CP shall hand over to the incoming CP on-site and all safety precautions are verified and understood by the incoming CP.
3. Transfer of permit shall be approved by the AP and communicated to the Control Person.
4. There are no changes in the environment impacting the validity of the risk assessment.
5. In case any of the above conditions are not met, the incoming CP shall request the AP to visit the site and confirm whether a new safety document shall be issued or the
job can proceed as is.
EXTENSION SECTION
1st Extension 2nd Extension
Date/Time
Valid Until
AP Name and Signature
Conditions:
1. The maximum validity of each extension is 3 days starting from the extension date.
2. AP and CP shall mutually approve the extension of the permit when the validity date expired and still work needs to be performed; revalidation of the permit shall be
communicated to the Control Person (in O&M) and Project Consultant/ Engineer for Capital Projects. For planned works, Operations Planning must agree to the extension
to control any simultaneous works.
3. Both the AP and CP must be on-site during the extension process to verify all risks are controlled.
