RETAIL PERMIT TO WORK SYSTEM –JOB HAZARD ANALYSIS

Will the work involve any of the activities below? (Circle any that apply)
Date: If ‘YES’ a Permit must be obtained

Prepared by:
Hot work in Hazardous areas Confined space entry Excavation >/= 1.2 m
Company:
Work on Flammable
Inerting or Gas Freeing Live Electrical Work
Retail Station Address: Gas Systems
Other (specify): Lifting
Asbestos Work Explosive Blasting work

Step
Job Steps Job Steps Hazards Job Steps Control
No.
Complete the Work Clearance Form (WCF) &  Unfamiliar with project scope &  TBT to be conducted by site In charge.
1
TBT. hazard involve in work  WCF & Safety document to be filled.

 Provide mobile barricade,

 Safety reflector jacket, helmet, safety shoes,
hand gloves & nose mask must be used on
 Traffic Hazard ,
site.
 Hit by vehicle,
2 Isolate work area / Install barricades  Provide sign board,
 Unauthorized person entry.
 Standing supervision to monitor traffic while
work on forecourt area,
 Only authorized person can enter into work
area.

Shell Retail Permit to Work _ Version 5.1

 RETAIL PERMIT TO WORK SYSTEM –JOB HAZARD ANALYSIS

 Accredited and experienced electrician to be

deployed for the work. (Safety passport is a
must – He cannot access site without this.)
 Cut off power supply of the STP. (LOTOTO)
Lock the switchboard circuits to the STP, Tag
3 Isolation of power supply  Electrocution
circuits, and test out isolation by trying to
start pump by lifting dispenser nozzle.
 Communication should be given to the
supervisor about applying/removal of
LOTOTO & shall be documented.
 Calibrated Gas tester available with
certificate and competency of the contractor
on its usage.
 Gas test to be conducted for LEL
 Fuel vapour  Leave the UGT sump open for some time to
 Defective gas detector allow vapour displacement if any
4 Gas-Test for the Tank Sump  Untrained person  All unsealed opening of the UGT/ TLD
 Fire hazard sensors /dip cap to be tightened not
 Body injury allowing vapour back to tank sump.
 Gas tester must be explosion proof
 Place the First aid kit & display ERP.
 Trained skilled & experience person only
allow to work

Shell Retail Permit to Work _ Version 5.1

 RETAIL PERMIT TO WORK SYSTEM –JOB HAZARD ANALYSIS

 GIDS Design standard for Fuel system

Mandatory standards, equipment
specification and assurance
 Local regulations
 Design Risk Assessment (DRA)
 Mandatory certification of the system
 Components
 Loss of containment leading to
 Provide regular maintenance, Critical
fatality,
Equipment Inspections (CEI) and testing.
 Personal injury,
 Use of accredited competent people with
 Environmental damage,
5 Shut Down DU ,STP & Nitrogen Purging approved equipment
 Asset damage
 Follow LOTOTO to isolate the energy
 Fire,
(electric, hydraulic, pressure, etc.).
 Explosion,
 Ensure proper commissioning of Fuel system
 Reputation damage.
equipment, installation and testing (GIDS
Documents).
 Carry out Last Minute Risk Assessment
 Execute the Emergency Response Plan.
 First aid Kits
 Safety reflector jacket, helmet, safety shoes,
hand gloves & nose mask must be used on
site.

Shell Retail Permit to Work _ Version 5.1

 RETAIL PERMIT TO WORK SYSTEM –JOB HAZARD ANALYSIS

 Provide standby fire Extinguisher,

 Provide sand buckets,
 Use anti spark tools.
 Water reflective vest while working at night,
 Isolate the work area & traffic management,
 Unauthorized tools.  Skilled & Trained person,
 Moving vehicle may hit to work  Standby supervision for High risk activities,
crew ( Where dispenser in  Trained & experience supervisor,
forecourt area),  JHA briefing to be done among the work
 Un skilled person, force team prior work,
 Lack of supervision,  Proper lighting arrangement to be done in
 Untrained supervisor, case of night work,
 Improper PPE,  Safety reflector jacket, helmet, safety shoes,
hand gloves & nose mask must be used on
 Slip fall,
site.
 Fumes.
 No hand phones allowed or smoking within
 Slippery surface,
the forecourt area
 Manual handling
 Keep body balance in correct position,
 Items/Equipment detaching from
6 Dismantling of Old DU(Tatsuno)  Ensure no slippery surface before start work.
the hoist and falling; incorrect
 Extra precaution to be taken.
manual handling during
lifting/hoisting  Apply any external mechanical support
where applicable (e.g. crane). The dispenser
 Electric shock
unit has weight 500 kgs approx. Eliminate
 Lack of ensured safe working area
any potential lifting/hoisting from person
 Positioning self in line with the
where applicable.
heavy equipment possible falling
 Fitness to Work of Crane Operator - Attend
pathway
annual physical examination and submit
 Failing to inspect the condition of
result of findings.
the lifting equipment and
 Certificate of Competency of Lifting
competence of operator
Equipment Operator
 Deviate from the approved work
- Bring certificate on site to show to auditors
methodology
-Contractor accreditation system
-Permit to Work system
-Safety/Worker Passport
-Lifting plans required.
-All workers to remain clear during lifting
operations (LSR's)

Shell Retail Permit to Work _ Version 5.1

 RETAIL PERMIT TO WORK SYSTEM –JOB HAZARD ANALYSIS

 Provide standby fire Extinguisher,

 Provide sand buckets,
 Use anti spark tools.
 Water reflective vest while working at night,
 Isolate the work area & traffic management,
 Skilled & Trained person,
 Standby supervision for High risk activities,
 Trained & experience supervisor,
 Unauthorized tools.  JHA briefing to be done among the work
 Moving vehicle may hit to work force team prior work,
crew ( Where dispenser in  Proper lighting arrangement to be done in
forecourt area), case of night work,
 Un skilled person,  Safety reflector jacket, helmet, safety shoes,
 Lack of supervision, hand gloves & nose mask must be used on
 Untrained supervisor, site.
 Improper PPE,  No hand phones allowed or smoking within
the forecourt area
 Slip fall,
 Keep body balance in correct position,
 Fumes.
 Ensure no slippery surface before start work.
 Slippery surface,
 Extra precaution to be taken.
 Manual handling
 Provide periodic material handling training
 Items/Equipment detaching from
7 Installation of new DU(Tokheim) to workers.
the hoist and falling; incorrect
manual handling during  Manual handling requirements to be
lifting/hoisting observed and when lifting items over 16kgs,
a second person is to help wherever
 Electric shock
possible.
 Lack of ensured safe working area
 Apply any external mechanical support
 Positioning self in line with the
where applicable (e.g. crane). The dispenser
heavy equipment possible falling
unit has approx 500 kgs weight. Eliminate
pathway
any potential lifting/hoisting from person
 Failing to inspect the condition of
where applicable
the lifting equipment and
 Fitness to Work of Crane Operator - Attend
competence of operator
annual physical examination and submit
 Deviate from the approved work
result of findings.
methodology
 Certificate of Competency of Lifting
Equipment Operator
- Bring certificate on site to show to auditors

Shell Retail Permit to Work _ Version 5.1

RETAIL PERMIT TO WORK SYSTEM –JOB HAZARD ANALYSIS

Shell Retail Permit to Work _ Version 5.1

 RETAIL PERMIT TO WORK SYSTEM –JOB HAZARD ANALYSIS

Personal Protective Equipment (PPE) appropriate to the task at hand shall be worn/used at all times.
Tick box any PPE that applies to this job

Any additional PPE appropriate to the task : Gas tester

List required equipment / tools (e.g fire extinguisher, barricading / signs , hand tools, mechanical tools, plant etc.):

Anti Sparking tools

Fire extinguisher

Barricading
Gas Tester

Crain

The work crew acknowledges that they understand and will comply with the precautions listed above

NAME: SIGNATURE:

NAME: SIGNATURE:

NAME: SIGNATURE:

NAME: SIGNATURE:

NAME: SIGNATURE:

Shell Retail Permit to Work _ Version 5.1