PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 1/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

PERMIT TO WORK

PROJECT : KARBALA REFINERY PROJECT

LOCATION : KARBALA, IRAQ

EMPLOYER : STATE COMPANY OIL PROJECTS (SCOP)

REVISED AS PER
5 30 DEC 20 H. S. Woo J. S. Ham B.H.Lee Y. B. Lim S.B.Park
MARKED
REVISED AS PER
4 08 NOV 20 H. S. Woo J. S. Ham B.H.Lee Y. B. Lim H.S.Hwang
MARKED
ISSUED FOR
3 06 NOV 19 Allan Cho J. S. Ham Y.S.Kim Y. B. Lim H.S.Hwang
CONSTRUCTION
REVISED FOR
2 03 AUG 19 Allan Cho J. S. Ham Y.S.Kim Y. B. Lim H.S.Hwang
COMMISSIONING
ISSUDED FOR
1 02 DEC 14 D. W. Youn W.S.Ann Y.S.Kim B.H.Shim H.S.Hwang
CONSTRUCTION
ISSUED FOR
0 20 OCT 14 D. W. Youn W.S.Ann Y.S.Kim B.H.Shim H.S.Hwang
CONSTRUCTION

A 20 AUG 14 ISSUED FOR REVIEW D. W. Youn W.S.Ann Y.S.Kim B.H.Shim H.S.Hwang

REVD REVD APPRD CONFD

REV. DATE DESCRIPTION PRPD CHKD
(PQM) (PM) (PD) (SCOP)

Joint Venture of Hyundai Engineering & Construction Co., Ltd., GS Engineering & Construction Co., Ltd., SK Engineering

& Construction Co., Ltd., and Hyundai Engineering Co., Ltd.,

Note :

a) Revision bar(vertical line) shall be placed in the right hand margin to indicate where the changes has been made

b) PRPD = Prepared by, CHKD = Checked by, REVD = Reviewed by, APPRD = Approved by, CONFD = Confirmed by

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
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Ref. FEED DOC. No. : 2342-AA00-JSM-701

REVISION HISTORY

Rev Date Description Page

A 20 AUG 14 Initial Issue -
Revised section 5.3, 5.5 and 6 to reflect
0 20 OCT 14 11, 14
EMPLOYER’s comments.
Revised section 2, 5.3 to reflect EMPLOYER’s
1 02 DEC 14 5, 10
comments.
2 03 AUG 19 Revised for Commissioning -
Reviewed and confirmed as per EMPLOYER’s
3 06 NOV 19 10
comments.(Refer to No. 5.2 Line 14)
4 08 NOV 20 Revised as per marked 7,10,17,21,25

5 30 DEC 20 Revised as per marked 6~8,10,12~17

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Ref. FEED DOC. No. : 2342-AA00-JSM-701

TABLE OF CONTENTS

1. Purpose ..................................................................................................................................................... 5

2. Scope ......................................................................................................................................................... 5

3. Responsibility ........................................................................................................................................... 5
3.1. HDGSK JV Project Director ........................................................................................................ 5
3.2. HDGSK JV HSE Manager ............................................................................................................ 5
3.3. HDGSK JV Area Construction Managers (Construction Area Authority) .............................. 5
3.4. HDGSK JV Construction Supervisor ......................................................................................... 6
3.5. HDGSK JV Area Commissioning Manager ............................................................................... 6
3.6. HDGSK JV Commissioning Section Engineer or Superintendent (Commissioning Area
Authority) .................................................................................................................................................. 6
3.7. Subcontractor’s Permit Holder .................................................................................................. 6

4. Definition ................................................................................................................................................... 7
4.1. Area Authority (Permit Issuer).................................................................................................... 7
4.2. Permit Holder ............................................................................................................................... 7
4.3. Permit Reviewer ........................................................................................................................... 7
4.4. Competent Person ....................................................................................................................... 7
4.5. Competent Person, Electrical ..................................................................................................... 7
4.6. Competent Person, Mechanical ................................................................................................. 7
4.7. Competent Person, Civil ............................................................................................................. 7
4.8. Competent Person, Lifting .......................................................................................................... 8
4.9. Competent Person, Excavation .................................................................................................. 8
4.10. Confined space ............................................................................................................................ 8
4.11. Gas testing ................................................................................................................................... 8
4.12. Permit To Work System ............................................................................................................... 8
4.13. Permit to Work Hand over........................................................................................................... 8
4.14. Standby Man ................................................................................................................................ 8
4.15. Fire Watcher ................................................................................................................................. 8
4.16. Authorized Gas Tester ................................................................................................................. 8
4.17. Radiation Protection Supervisor ................................................................................................ 9
4.18. First Aider ..................................................................................................................................... 9
4.19. Isolation/DE-Isolation Certificate ............................................................................................... 9

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5. Procedure .................................................................................................................................................. 9
5.1. Preliminary ................................................................................................................................... 9
5.2. General ......................................................................................................................................... 9
5.3. PTW Application process ......................................................................................................... 10
5.4. Validity of Permits....................................................................................................................... 11
5.5. Revalidation ................................................................................................................................ 11
5.6. Permit Holder Signing Off .......................................................................................................... 11
5.7. Classification of Work Permit. ................................................................................................... 11
5.8. Standard Forms ......................................................................................................................... 17
5.9. Identification of Authorized Personnel & Alternates ............................................................. 17

6. Reference ................................................................................................................................................ 17
6.1. IONE-AA00-PE-HS-0001 Project HSE Plan .............................................................................. 17
6.2. IONE-AA00-PE-HS-0004 Tool Box Meeting ............................................................................. 17
6.3. IONE-AA00-PE-HS-0020 Lock Out Tag Out ............................................................................. 17
6.4. IONE-AA00-PE-HS-0024 Working at Height ............................................................................ 17
6.5. IONE-AA00-PE-HS-0025 Confined Space ................................................................................ 17
6.6. IONE-AA00-PE-HS-0026 Excavation ........................................................................................ 17
6.7. IONE-AA00-PE-HS-0028 Hot Work ........................................................................................... 17
6.8. IONE-AA00-PE-HS-0029 Lifting Safety .................................................................................... 17
6.9. IONE-AA00-PE-HS-0041 Radiography Safety ......................................................................... 18
6.10. IONE-AA00-PE-HS-0050 Pre-commissioning & Commissioning HSE Plan......................... 18
6.11. IONE-AA00-PE-HS-0051_Simultaneous Operations Procedure ........................................... 18

7. Appendices ............................................................................................................................................. 18
7.1. The Permit to Work Flowchart .................................................................................................. 18
7.2. The Standard Permit to Work Forms (For Construction Area) ............................................. 18
7.3. Revalidation sheet (For Construction Area) ........................................................................... 18
7.4. The Standard Permit to Work Forms (For Commissioning Area) ......................................... 18
7.5. Revalidation sheet (For Commissioning Area) ....................................................................... 18
7.6. Identification of Authorized Personnel and Alternates .......................................................... 18
26

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Ref. FEED DOC. No. : 2342-AA00-JSM-701

1. Purpose

This procedure and guidance information has been developed to establish a uniform system for the
issuance of permits to work in such a way that a hazardous and/ or high risk activities can be carried out
in a safely manner as possible.

2. Scope

This procedure is to be used by members of the HDGSK JV, its Sub-contractors Project Management
Team, Supervisors and Subcontractors who directs, supervises and control hazardous activities where a
permit to work is necessary.

This procedure has been updated for applying to all stages (Construction, Pre-Commissioning,
Commissioning) of this project.

3. Responsibility

3.1. HDGSK JV Project Director

3.1.1. The HDGSK JV Project Director has overall responsibilities for ensuring that provisions are
made for the implementation of Safe Systems of Work including planning for Permit to Work
durations.
3.1.2. The implementation of the "Permit to Work (PTW)" scheme shall be the joint responsibility of
the HDGSK JV Project Director and the HDGSK JV HSE Manager, with full assistance from
the HDGSK JV Construction/Commissioning Manager, Delegated personnel and
Subcontractors Permit Holder nominated personnel.

3.2. HDGSK JV HSE Manager

3.2.1. Establishing and maintaining training programs and competence standards

3.2.2. Implementing monitor and review of the effectiveness of PTW
3.2.3. Auditing the PTW System

3.3. HDGSK JV Area Construction Managers (Construction Area Authority)

3.3.1. Responsible for the review of permit to work application on construction area.
3.3.2. Ensuring all hazards and risks are adequately addressed in consultation with the
subcontractors Project Manager and/ or construction field supervisors.
3.3.3. Monitoring of the work in progress to ensure compliance with the conditions set forth in the
PTW permit/s.
3.3.4. Suspension of non-compliance activities and withdrawal/ cancellation of non-compliance PTW.

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3.4. HDGSK JV Construction Supervisor

3.4.1. Responsible for the monitoring the commencement of permit at construction area. 5
3.4.2. Monitoring of the work in progress to ensure compliance with the conditions set forth in the
PTW permits.
3.4.3. Assigning competent person to the work as required.
3.4.4. Suspension of non-compliance activities and reporting it to HDGSK JV Area Construction
Managers or HSE Manager Supervisor.

3.5. HDGSK JV Area Commissioning Manager

Responsible for managing overall PTW system and monitor its implementation in Pre-Commissioning
and Commissioning area.

3.6. HDGSK JV Commissioning Section Engineer or Superintendent (Commissioning Area

Authority)

3.6.1. Responsible for the approval of permit to work application on pre-commissioning and
commissioning area.
3.6.2. Monitoring of the work in progress to ensure compliance with the conditions set forth in the
PTW permits.
3.6.3. Assigning competent electrical and mechanical personnel to perform and certify isolations as
required by the Lock Out / Tag Out Procedure in Commissioning Controlled Areas.
3.6.4. Controlling the issuance of clearance tags for access to Commissioning Controlled Area.
3.6.5. Suspension of non-compliance activities and withdrawal/ cancellation of non-compliance PTW.
3.6.6. Controlling the issuance of isolation/de-isolation certificate when permit is required to check
Lock Out / Tag Out status.

3.7. Subcontractor’s Permit Holder

The Permit Holder’s responsibilities include but are not limited to;

3.7.1. Ensuring the proper authorization of designated work such as certain type of work, extent of
job, related hazard and limitations.
3.7.2. Ensuring that adequate precautions are made and maintained throughout the work activities
as stated in the permit to work JHA and Risk Assessment.
3.7.3. Ensuring that on completion or suspension of work, the site is left in a safe condition and the
Area Authority (Permit Issuer) is adequately informed.
3.7.4. Ensuring that the plant and equipment is left in a safe condition after work is finished.
3.7.5. Ensure PTW is present during toolbox meeting and all conditions of the PTW were
communicated to all members of the team. The PTW must be present at all times during
execution of the activity.
3.7.6. Ensure strict implementation and compliance of the PTW procedures.
3.7.7. Ensure pre-start meeting for sharing JHA & Risk assessment of work which applied by permit

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to work system.

4. Definition

4.1. Area Authority (Permit Issuer)

A Technical Specialist of the disciplined work with responsibility for defining the control measures to
be put in place to control and manage the work in an area or particular discipline.

Permit Issuer is limited to assigned person by HDGSK JV Area Construction Managers in a

construction activities or Commissioning Section Engineer/Superintendent in a Commissioning
Activities. 5

Permit issuer should be completed Permit to Work Training course including examination which
providing by HDGSK JV.

4.2. Permit Holder

The person/s responsible for completing the Permit to Work application, directing and supervising
the work being carried out and ensuring full compliance with all conditions of the permit to work. Also,
safety supervisor should not be permitted to process permit to work as permit holder.

HSE People will only review PTW not sign them on. Permit holder is limited to assigned person by
Task Team Engineer/Supervisor. PTW work holder must be trained by issuing authority and be
foreman / supervisor level appointed by Construction or Commissioning Manger. 5

4.3. Permit Reviewer

The person/s responsible for reviewing the Permit to Work processing and monitoring the work being
carried out and reviewing full compliance is fulfilling as per Permit to Work requirement.

4.3.1. In Construction activities, permit reviewer will be assigned by HDGSK JV HSE Team
4.3.2. In a Commissioning activities, permit reviewer will be assigned from HDGSK JV Construction
Manager and HDGSK JV HSE Team.
4.3.3. PTW shall be reviewed at the place of the work activities.
4.4. Competent Person

A competent person is person who has skill, knowledge, training, experience, abilities and authorized
to carry out defined work through internal training and 3rd party training with certificate.

4.5. Competent Person, Electrical

A competent person who is approved by HDGSK JV Electrical Manager to carry out the preparation 5
to isolate/de-isolate electrical appliance and/ or equipment up to a predetermined voltage.

4.6. Competent Person, Mechanical

A competent person who is approved by HDGSK JV Mechanical Manager to carry out the preparation
and control of mechanical isolation of process equipment.

4.7. Competent Person, Civil

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A competent person who is approved by HDGSK JV Civil Manager to carry out the planning,
preparation and execution of the civil work in a safe manner.
5
4.8. Competent Person, Lifting

A competent person who has been approved to carry out the lifting preparation and perform the lifting
work in safe a manner.

4.9. Competent Person, Excavation

A competent person who has been approved to carry out the excavation preparation and perform
the excavation work in a safe manner.

4.10. Confined space

A space that is large enough and so configured that an employee can bodily enter and perform
assigned work.

 Has limited or restricted means for entry or exit.

 Has unfavorable natural ventilation which could contain or produce dangerous air
contaminants; presents serious hazards to occupants; or which is not intended for
continuous employee occupancy.
4.11. Gas testing

A test conducted to measure the existence and/or concentrations of toxic gas or flammable gases,
such as O2, CO2, CO, NO2, H2S secure safe workplace.

4.12. Permit To Work System

The system that allows central control and ongoing monitoring of higher risk activities to ensure that
activities are;

 Authorized.
 Carried out by qualified personnel using appropriate safety precautions.
 Those activities with potentially hazardous interactions do not take place at the same time.

4.13. Permit to Work Hand over

The Permit to Work transfer to other parties to complete the work.

4.14. Standby Man

A person who has been briefed and competent on the emergency procedures and equipment
necessary for confined space entries.

4.15. Fire Watcher

A person assigned to the duties of fire suppression and prevention necessitated by hot work activities.

4.16. Authorized Gas Tester

Personnel who are authorized and trained (Authorized Gas Tester Training by 3rd party services) in
the use of gas testing equipment.

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4.17. Radiation Protection Supervisor

The person appointed by the N.D.T (or other) company as the classified person responsible for
supervising work with radiation sources on site.

NOTE: The actual job titles as defined may differ depending on Project Management terms specific
to site, however, the job titles used on project must reflect the authorization of the persons concerned.

4.18. First Aider

A person who provide initial care for an illness or injury until definitive medical treatment action, such
as investigating, considering or acting on a safety matter.

4.19. Isolation/DE-Isolation Certificate

In a Commissioning activities, Subcontractor/Permit Holder group require work in energizing location,

commissioning team issuing certificate for Lock out processing due to Permit to Work complying.

5. Procedure

5.1. Preliminary

During construction/commissioning, the activities tabled below shall require both permission and
certification prior to work commencing. Example permit to work forms can be found in the enclosures
to this document.

Prior to conduct activity, each permit shall be analyzed and approved by permit issuer or
commissioning area authority for in case of commissioning area, then approved permit shall be
submitted to permit control room a day before when activity conducted.

5.2. General

The work permit is a written document and includes.

 Competent persons to carry out the work activities.

 Warns of possible hazards associated with the work.
 Clearly states the HSE precautions to be taken for the work to be carried out safely.
 The permit specifies the particular equipment and construction methods to be implemented.
 The extent of the work and location.
 Job Hazard Analysis and Risk Assessment.
 Conditions to be observed.
 Duration of the permit.
 Specific number of members.
 Certification for associated works like excavation, underground utilities, vehicle entry, lifting.
 Pre-start Meeting Attendant Record.
 Radiation documents, details on the source to be used, and a Plot plan with exclusion zone
marked on.
 Specific Crane Load Chart of crane lifting work permit.

Training shall be provided for qualification to conduct specific tasks such as Hot works, Confined
Spaces, Electrical Work, Working at Height, Excavation and Energy Isolation. Training should be
provided for individual prior to their assignment start.

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Third party training shall be provided for qualified personnel & equipment such as Lifting works
(Crane lifting, Rigging), Gas testing, Working at Height (Scaffolding Work).

5.3. PTW Application process

Application shall be made by the Permit Holder who shall supply all information and required
attachment/s relevant to the scope of works on the relevant permit forms.

The Area Authority (Permit Issuer) shall review the precautions necessary to carry out the work safely.
The Area Authority (Permit issuer) must first check that the work method statement and risk
assessment adequate to carry out the activity safely before signing the PTW in a location as close
to the work activity as can be safely achieved to ensure that the Permit is issued in a safe work
location free from hazards.

Provision of "Work Method Statements" may be necessary and shall be attached to the permit.

Preventative measures shall be identified by the Area Authorities (Permit Issuer) in conjunction with
the Permit Holder and reviewed by HSE department.

When the Area Authority (Permit Issuer) is satisfied that all conditions have been met in preparing
the area to be worked on, the Area Authority (Permit Issuer) shall discuss the measures taken and
precautions required to carry out the job safely with the Permit Holder and the HSE department as
required.

When the Permit Holder is satisfied, he shall sign acceptance of the terms and conditions set out in
the permit for doing the work.

*Note
 On signing the acceptance, Permit Holder accepts responsibility for the work activity and the
work area.
 Both the Issuing authority and the permit holder shall visit the work activity location and check
5
for the compliance of health and safety requirements before any permit is signed off.

The Area Authority (Permit Issuer) shall also sign to indicate approval and share of responsibility to
the Permit Holder.

The PTW is to be sent to the HSE department PTW document controller for recording and tracking.

A copy of the PTW is to be retained at the HSE office record and the original copy posted at the
visible location such as PTW board or box which installed nearby of the workplace (i.e confined 5
space work/entry, NDT, Hazardous substance handing, excavation, lifting, commissioning area, etc).
All team members are to be made aware of its content and requirements for the works.

If there is shift change during designated work, the Permit to Work and detailed information on the
work shall be transferred to other authorized permit holder. In that case, the Area Authority (Permit
Issuer) or his nominee shall regularly monitor whether the work is going as planned.

Permits should be returned to ‘Permit Control Office (HSE Office)’ after closed out by both Area
Authority (Permit Issuer) and Permit Holder.

5.3.1. Construction Area

Work permit, as refer to Appendices 7.2, shall be followed for Construction area.

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5.3.2. Commissioning Area

Work permit, as refer to Appendices 7.3, shall be followed for Commissioning area. When The
Area Authority and Permit Holder are satisfied, the permit shall be confirmed by HDGSK JV
Commissioning authority.
The permit shall be separated by each specific location and sub-system(Unit).
All relevant associated work permit shall be submitted together if activity is involved, and get
confirmed by HDGSK JV Commissioning authority.
When permit is to be closed, it is needed to be informed to HDGSK JV commissioning and get
confirmed of its results.

5.4. Validity of Permits

The following is the length of validity for each permit/s applied;

All permit : Seven (7) days’ maximum

Permits needs to be re-applied after the end of the duration of permit, validity in case the work is
continued.

5.5. Revalidation

The Area Authority (Permit Issuer) shall re-approve the recommencement of work by signing the
date/shift of revalidation (7 days maximum). This must be accomplished after the day’s tool box
meeting before the start of work.

Until permit holder, permit issuer sign on daily revalidation sheet, commissioning area authority also
must do same process in commissioning area, otherwise, permit shall not be activated.

If there is change of conditions and permit condition could not cover it, the permit should be closed-
out and re-issue the permit.

5.6. Permit Holder Signing Off

When the Permit Holder is satisfied that the permitted work has been completed or suspended for a
sufficient length of time to warrant the permit closure, the Permit Holder and the Area Authority
(Permit Issuer) shall both sign off the PTW.

The Permit Holder shall ensure on completing the work that;

 Permit requirements have been cleared.

 Materials have been cleared and housekeeping done.
 Personnel removed from the work area.
 All necessary personnel have been informed.

Note: Completed Permits will be return to HDGSK JV PTW Reviewer (HSE) for closing of the permit
and kept in a master file to maintain history of the work carried out. These documents in some cases
can be used in litigation and should be treated as Legal documents.

5.7. Classification of Work Permit.

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When work is generally conducted on the site, general work permit shall be written by permit holder.
However, if work area is considered as the area where commissioning activity is being conducted or
exist any potential hazard due to it, work permit shall be followed according to work permit for
commissioning area.

5.7.1. General Work Permit for Construction Area

5.7.1.1. Hot Work
Hot Work Permit shall be prepared when the work that involves burning, welding, cutting,
brazing, soldering, grinding, using fire- or spark-producing tools, or other work that
produces a source of ignition.
5
Safety requirements below should be reviewed while issuing hot work permit but not
limited to;
 Fire Extinguisher or Fire Hose Reel available
 Combustible material Removed
 Designated Fire Watch available
 Welding Fire Blanket
 Energy Source can be locked and tagged
 Equipment Inspected & correctly color coded
 Signs & Barricades Posted
 All wall and Floor Opening covered
 Ensure Fire Watch for 30 minutes after work
 Use of PPEs (Safety goggles, Face shield, Hot burn protective clothing, etc.)
Refer to HDGSK JV HSE procedure, IONE-AA00-PE-HS-0028 Hot Work

5.7.1.2. Elevated Work

Elevated Work Permit shall be prepared whenever the work or activity will require
working on elevations 1.8 meters and above.
For more information, refer to HDGSK JV HSE procedure, IONE-AA00-PE-HS-0024
Working at Height.

5.7.1.3. Excavation Work

Excavation Work Permit should be prepared with documents below but not limited to;
 Risk Assessment and JHA
5
 Drawings which marked up identified underground facilities
 Deep Excavation Checklist (more than 3 meters’ depth)

Refer to HDGSK JV HSE procedure, IONE-AA00-PE-HS-0026 Excavation.

5.7.1.4. Crane Lifting

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Associated Work permit which shall be prepared on any activity that require to lift with
crane.
Crane Lifting Permit should be prepared with documents below but not limited to;
 Risk Assessment and JHA
 Load chart 5

 Certification of the Crane and Lifting Gears

 Certification of the Crane Operator
 General Lifting Plan
 Approved Critical Lifting Plan for critical lifting

For more information, refer to HDGSK JV HSE procedure, IONE-AA00-PE-HS-0029

Lifting Safety.

5.7.1.5. Night Holiday Work

Night Holiday Work permit shall be issued to conduct activity on Holiday or Night time.
Safety requirements below should be reviewed while issuing Night Holiday Work Permit
but not limited to;
 Lighting & illumination on the Job site
5
 Adequate illumination on access roads
 First Aider available at each job activity (ratio 1 for every 100)
 Adequate Supervision
 Transportation Provided
 Tool Box Meeting Conducted

5.7.1.6. Road Closure

Associated work permit to block the road due to lifting activity, excavation, etc. The permit
shall be carried out subject to 72 hours’ notification.
Safety requirements below should be reviewed while issuing Road Closure Permit but
not limited to;
 Safe Detour Route provided 5
 Proper Signage for Detour
 Hard barrier with Proper Road Signs
 Appropriate Warning Signage in place
 Flagman / Traffic Controller available
 Blinker Lights for lights provided for night
 Medical Clinic & Ambulance driver notified
 Notification to all concerned

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Ref. FEED DOC. No. : 2342-AA00-JSM-701

5.7.1.7. Abrasive Blasting

Associated work permit to conduct abrasive blasting activity.
Safety requirements below should be reviewed while Abrasive Blasting Permit but not
limited to;
 Appropriate PPEs provided (hood, respiratory protections, etc.) 5
 Barricade for preventing unauthorized access
 Combustible material Removed
 Sign posted "No Entry-Abrasive Blasting"
 Blasting Equipment grounding and bonding
 Blaster designed to shut off automatically
 Periodic clean up the area
 Sufficient Fire Extinguisher
 Blast residue cleaned up/disposed properly

5.7.1.8. Grating Removal

Associated work permit to remove grating for other activity. Specific reason shall be
mentioned on permit and all safety method shall be prepared to eliminate hazards with
permit.

Safety requirements below should be reviewed while Abrasive Blasting Permit but not
limited to;
 Use of correct tools & tackles
5
 Temporary Hard Barricades or Cover
 Caution sign all sides for preventing unauthorized access
 No loose materials on the floor
 Life line / Anchorage
 Scaffold tag system in place
 Sufficient Replacement Clips- Available
 Trained Grating Removal Personnel and Supervision
 "OPEN HOLE-DANGER, DO NOT REMOVE" caution board in place

5.7.1.9. Radiography
Radiography shall only be carried out by competent persons, following a review of their
local working rules and such activities will be programmed wherever possible after
normal working hours. Notification include marked up plot plan with safety distance,
working time should be noticed to all contractors at least 12hours before commence the 5
work.

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 15/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

For more information, refer to HDGSK JV HSE procedure, IONE-AA00-PE-HS-0041

Radiography Safety.

5.7.1.10. Confined Spaces

Minimum requirements are that adequate measure shall be in place to effect procedures
and responses to emergencies that cover all personnel involved in the operations.
Entries will only take place after the area has been checked by the subcontractor’s
trained, qualified and appointed representative on site. Mandatory gas testing for
breathable atmosphere will be carried out prior to entry.

All pipes which connected to the confined spaces should have blind or air gaps to
prevent unexpected flow of energy source or hazardous atmosphere. 5

Any confined space that may have contained Nitrogen must be opened up and ventilated
72 hours before any planned work or mechanically ventilate to fresh air with ventilator,
then made atmospheric test in the confined space to ensure that sufficient level of the
oxygen or not presences of any hazards.

For more information, refer to HDGSK JV HSE procedure, IONE-AA00-PE-HS-0025

Confined Space.
a) Gas Test

A record of gas tests shall be conducted by suitably trained, qualified and

experienced person. Results of the gas test will be entered into a register stating
the time and frequency of interval the test is conducted during the course of the
work. HDGSK JV HSE department will maintain register of trained and qualified
personnel for gas testing
Gas testing instruments shall be calibrated on a periodic basis according to the vendor
recommendations or when condition warrants.
The requirement for ongoing testing (ex; qualification of gas tester, frequency of testing
etc.) will be specified and attached on the permit form.

5.7.2. Work Permit for Commissioning Area

On commissioning area, where the area is restricted to approach without permission under
the commissioning activity has potential hazard due to commissioning, one of below work
permit shall be arisen to request to enter the restricted area and conduct any work.
All permit shall have Risk Assessment and JHA. 5
Moreover, the work shall be planned in coordination meeting and work permit for
commissioning area could be activated after confirmation by designated area authority of
commissioning.
5.7.2.1. Cold work Permit
Cold work does not require or create enough heat to ignite flammable gas-air mixtures

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 16/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

of flammable materials in operating units during commissioning.

5.7.2.2. Hot work Permit

Any hot work where hydrocarbons have been introduced will need permission from
Commissioning Area Authority. 5
Refer to HDGSK JV HSE procedure, IONE-AA00-PE-HS-0028 Hot Work

5.7.2.3. Pre-Commissioning / Commissioning Permit

Pre-Commissioning / Commissioning permit shall be prepared to conduct any activity on
entire site area on that period. Moreover, all associated work permit shall be submitted
with Pre-commissioning / Commissioning permit.
For more information, refer to the HDGSK JV HSE procedure, IONE-AA00-PE-HS-0050
Pre-commissioning & Commissioning HSE Plan.
Further, any energizing area require to applying work, refer to the HDGSK JV HSE
procedure, IONE-AA00-PE-HS-0020 Lock Out Tag Out

5.7.3. Associated Work Permit for Commissioning Area

In addition to work permit for commissioning area (Cold work permit, Hot work permit, Pre-
Commissioning/Commissioning permit), associated work permit shall be written & attached if
the activity is involved with each type of associated work permit.
However, each form of associated work permit (Commissioning activities) shall be different
from a form of general work permit of Construction activities.

5.7.3.1. Working at Height permit

Associated work for Working at Height shall be prepared whenever work or activity will
require working on elevations 1.8 meters and above in commissioning activities.
Safety requirements below should be reviewed while Working at Height permit but not
limited to;
 Prepare necessary document such as Risk Assessment and JHA 5
 Ensure that sufficient access/egress
 Prepare rescue plan (if needed)
 Provide and worn appropriate fall protection PPEs
 Provide physical fall protection facilities such as handrail, lifeline, anchoring point,
etc.

5.7.3.2. Electrical Work permit

Associated work for electrical shall be prepared whenever work or activity will require
the use of energized electrical source during commissioning area. The form and
checklist must be fully completed and necessary revalidation sheet shall also be included.
5

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 17/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

5.7.3.3. Confined Space Work permit

Associated work for Confined Space shall be prepared whenever work or activity will
require working in Confined space which mentioned type of activities on HDGSK JV HSE
procedure, IONE-AA00-PE-HS-0025 Confined Space in commissioning activities.

5.7.3.4. Radiography Work permit

Associated work for Radiography shall be carried out by competent person and
complying local regulation, isolating from normal working hours in commissioning
activities.
In case of any activity clashes, SIMOPS procedure such as SIMOPS coordination
meeting shall be applied before issuing Radiography Work permit.
5

Refer to the IONE-AA00-PE-HS-0051_Simultaneous Operations Procedure

5.7.3.5. Excavation Work permit

Associated work for Excavation shall be conduct interface meeting with commissioning
team for cross check whenever having energizing unit are available if any excavation
work required in commissioning activities.

5.8. Standard Forms

The "Permit to Work" form/s is designed to cover most eventualities arising on site. Other attachment
necessary and required for the PTW will be included in a part of the permit.

5.9. Identification of Authorized Personnel & Alternates

The authorized personnel shall be recorded by “Identification of Authorized Personnel and Alternates”
form. Permit to work and other relevant document shall be signed by authorized personnel &
alternates register.

The Identification of authorized personnel is required to update every month.

6. Reference

6.1. IONE-AA00-PE-HS-0001 Project HSE Plan

6.2. IONE-AA00-PE-HS-0004 Tool Box Meeting
6.3. IONE-AA00-PE-HS-0020 Lock Out Tag Out
6.4. IONE-AA00-PE-HS-0024 Working at Height
6.5. IONE-AA00-PE-HS-0025 Confined Space
6.6. IONE-AA00-PE-HS-0026 Excavation
6.7. IONE-AA00-PE-HS-0028 Hot Work
6.8. IONE-AA00-PE-HS-0029 Lifting Safety

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 18/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

6.9. IONE-AA00-PE-HS-0041 Radiography Safety

6.10. IONE-AA00-PE-HS-0050 Pre-commissioning & Commissioning HSE Plan
6.11. IONE-AA00-PE-HS-0051_Simultaneous Operations Procedure

7. Appendices

7.1. The Permit to Work Flowchart

7.2. The Standard Permit to Work Forms (For Construction Area)
7.3. Revalidation sheet (For Construction Area)
7.4. The Standard Permit to Work Forms (For Commissioning Area)
7.5. Revalidation sheet (For Commissioning Area)
7.6. Identification of Authorized Personnel and Alternates

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 19/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.1] (1) Permit To Work Flow Chart

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 20/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.1] (2) Permit To Work Flow Chart

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 21/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (1) The Standard Permit To Work Forms (For Construction Area)
KARBALA REFINERY PROJECT

HOT WORK PERMIT

PTW No. :
Part 1: Work Details. (To Be Filled By Subcontractor Engineer or CM)
Application Date: Start Date & Time: Completion Date & Time Company: JHA Attached:
YES □ No □
Location : Tools & Equipment to be Used Certificates Checked
Operators: YES □ N/A □

Equipment: YES □ N/A □

Describe Exactly
Work to be done:

Permit Holder Name: Date/Time: Signature: Tel:

Part 2: Specific Safety Precaution. (To Be Filled By Subcontractor PTW Holder or Safety)

Preparation YES NO Safety Precaution YES NO Gas Test

Safety Googles □ □ Fire Extinguisher or Fire Hose Reel available □ □ Required

Face Shield □ □ Combustible material Removed □ □ YES □ No □
Hot Burn Protective Clothing □ □ Designated Fire Watch available □ □
Appropriate Gloves □ □ Welding Fire Blanket □ □ IF YES Then Gas
Hearing Protection □ □ Energy Source can be locked and tagged □ □ Test Results to be
Respirotary Protection □ □ Equipment Inspected & correctly color coded □ □ Recorded on PTW
Full Body Harness □ □ Signs & Barricades Posted □ □ "Gas Test Record
Rubber Boots □ □ All wall and Floor Opening covered □ □ form"
□ □ Ensure Fire Watch for 30 minutes after work □ □

Part 3: Acceptance (To Be Filled By JV HSE or PTW Coordinator)

JV Safety
Comment:

Reviewer Name: Date/Time: Signature: Tel:

Part 4: Issue and Validity (To Be Filled By JV Engineer or CM)

I am Aware of the conditions on this Permit, they have been discussed with the JHA and I confirm that the Safety Precautions as attached
to the Work Permit and certificates will be strictly observed. All personnel under My control shall be briefed through TBT accordingly.

Issuer Name: Date/Time: Signature: Tel:

Part 5: Close Out (To Be Filled By Holder and Reviewer)

The work is completed and working area has been cleared The site has been checked and working area accepted
from debris and equipment

Holder (Subcontractor Engineer or CM) Reviewer (JV HSE or PTW Coordinator)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 22/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (2) The Standard Permit To Work Forms (For Construction Area)

KARBALA REFINERY PROJECT

EXCAVATION & TRENCHING WORK PERMIT

PTW No. :
Part 1: Work Details. (To Be Filled By Subcontractor Engineer or CM)

Application Date: Start Date & Time: Completion Date & Time Company: JHA Attached:
YES □ No □
Location : Tools & Equipment to be Used Certificates Checked
Operators: YES □ N/A □

Equipment: YES □ N/A □

Describe Exactly
Work to be done:

Permit Holder Name: Date/Time: Signature: Tel:

Part 2: Specific Safety Precaution. (To Be Filled By Subcontractor PTW Holder or Safety)

Preparation YES NO Safety Precaution YES NO Gas Test

Safety Googles □ □ All utilities & line identified before beginning□ □ Required
Face Shield □ □ Spoil piles at least 0.6m from the edge □ □ YES □ No □
Hot Burn Protective Clothing □ □ Qualified person make daily inspections □ □
Appropriate Gloves □ □ No person when Power equipment operating □ □ IF YES Then Gas
Hearing Protection □ □ Adequate sloping and access provided □ □ Test Results to be
Respirotary Protection □ □ Ladder extended 1m above top of excavation □ □ Recorded on PTW
Full Body Harness □ □ Heavy equipment not permitted within 1.5m □ □ "Gas Test Record
Rubber Boots □ □ Equipment Inspection & color coding □ □ form"
□ □ Signs & Barricades Posted □ □

Part 3: Acceptance (To Be Filled By JV HSE or PTW Coordinator)

JV Safety
Comment:

Reviewer Name: Date/Time: Signature: Tel:

Part 4: Issue and Validity (To Be Filled By JV Engineer or CM)

I am Aware of the conditions on this Permit, they have been discussed with the JHA and I confirm that the Safety Precautions as attached
to the Work Permit and certificates will be strictly observed. All personnel under My control shall be briefed through TBT accordingly.

Issuer Name: Date/Time: Signature: Tel:

Part 5: Close Out (To Be Filled By Holder and Reviewer)

The work is completed and working area has been cleared The site has been checked and working area accepted
from debris and equipment

Holder (Subcontractor Engineer or CM) Reviewer (JV HSE or PTW Coordinator)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 23/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (3) The Standard Permit To Work Forms (For Construction Area)

KARBALA REFINERY PROJECT

CONFINED SPACE ENTRY WORK PERMIT

PTW No. :
Part 1: Work Details. (To Be Filled By Subcontractor Engineer or CM)

Application Date: Start Date & Time: Completion Date & Time Company: JHA Attached:
YES □ No □
Location : Tools & Equipment to be Used Certificates Checked
Operators: YES □ N/A □

Equipment: YES □ N/A □

Describe Exactly
Work to be done:

Permit Holder Name: Date/Time: Signature: Tel:

Part 2: Specific Safety Precaution. (To Be Filled By Subcontractor PTW Holder or Safety)

Preparation YES NO Safety Precaution YES NO Gas Test

Safety Googles □ □ Energy Source locked & tagged □ □ Required

Face Shield □ □ Personnel monitors to be carried □ □ YES □ No □
Hot Burn Protective Clothing □ □ Stand by man at entry point required □ □
Appropriate Gloves □ □ Confined Space Entry/Exit Log □ □ IF YES Then Gas
Hearing Protection □ □ Suitable illumination provided □ □ Test Results to be
Respirotary Protection □ □ Auxilliary Ventilation Required □ □ Recorded on PTW
Full Body Harness □ □ Rescue system in place □ □ "Gas Test Record
Rubber Boots □ □ Communication system provided □ □ form"
□ □ Prohibited Signs from unauthorized entry □ □

Part 3: Acceptance (To Be Filled By JV HSE or PTW Coordinator)

JV Safety
Comment:

Reviewer Name: Date/Time: Signature: Tel:

Part 4: Issue and Validity (To Be Filled By JV Engineer or CM)

I am Aware of the conditions on this Permit, they have been discussed with the JHA and I confirm that the Safety Precautions as attached
to the Work Permit and certificates will be strictly observed. All personnel under My control shall be briefed through TBT accordingly.

Issuer Name: Date/Time: Signature: Tel:

Part 5: Close Out (To Be Filled By Holder and Reviewer)

The work is completed and working area has been cleared The site has been checked and working area accepted
from debris and equipment

Holder (Subcontractor Engineer or CM) Reviewer (JV HSE or PTW Coordinator)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 24/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (4) The Standard Permit To Work Forms (For Construction Area)

KARBALA REFINERY PROJECT

CRANE LIFTING WORK PERMIT Critical Lift

Non Critical Lift

PTW No. :
Part 1: Work Details. (To Be Filled By Subcontractor Engineer or CM)

Application Date: Start Date & Time: Completion Date & Time Company: JHA Attached:
YES □ No □
Location : Tools & Equipment to be Used Certificates Checked
Operators: YES □ N/A □

Equipment: YES □ N/A □

Critical Lift Plan required YES □ No □ Trial Lift & LMI Check required YES □ NO □
Describe Exactly
Work to be done:

Permit Holder Name: Date/Time: Signature: Tel:

Part 2: Specific Safety Precaution. (To Be Filled By Subcontractor PTW Holder or Safety)
Safety Precaution YES NO Crane Capacity: tons

Ground stablity OK □ □
Weather Conditions OK □ □ A= meters
Outrigger fully extended and Pad in good condition □ □ B= meters
Pick up & Drop Paths identified and Checked □ □ C= tons
Rigging equipment inspected and correctly color coded □ □ D= tons
Lifting area controlled and barricaded properly □ □
Daily Crane Checklist completed by certified operator □ □ Total lifting Weight (C+D) = tons
Certified Rigger assigned □ □ Actual Lifting Capacity at set up (F)= tons
Slings & Shackles inspected & Secured by certified Rigger □ □ Current % Crane Capacity [(C+D)/F]= %
*Refer to the attached detailed lifting plan for critical lifting
Part 3: Acceptance (To Be Filled By JV HSE or PTW Coordinator)

JV Safety
Comment:

Reviewer Name: Date/Time: Signature: Tel:

Part 4: Issue and Validity (To Be Filled By JV Engineer or CM)

I am Aware of the conditions on this Permit, they have been discussed with the JHA and I confirm that the Safety Precautions as attached
to the Work Permit and certificates will be strictly observed. All personnel under My control shall be briefed through TBT accordingly.

Issuer Name: Date/Time: Signature: Tel:

Part 5: Close Out (To Be Filled By Holder and Reviewer)

The work is completed and working area has been cleared The site has been checked and working area accepted
from debris and equipment

Holder (Subcontractor Engineer or CM) Reviewer (JV HSE or PTW Coordinator)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 25/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (5) The Standard Permit To Work Forms (For Construction Area)

KARBALA REFINERY PROJECT

ELEVATED WORK PERMIT [Above 1.8m for any activities]

PTW No. :
Part 1: Work Details. (To Be Filled By Subcontractor Engineer or CM)

Application Date: Start Date & Time: Completion Date & Time Company: JHA Attached:

YES □ No □
Location : Tools & Equipment to be Used Certificates Checked
Operators: YES □ N/A □

Equipment: YES □ N/A □

Describe Exactly
Work to be done:

Permit Holder Name: Date/Time: Signature: Tel:

Part 2: Specific Safety Precaution. (To Be Filled By Subcontractor PTW Holder or Safety)

Preparation YES NO Safety Precaution YES NO

Safety Googles □ □ Access and Walk way are Clear and free of obstruction □ □
Face Shield □ □ Scaffolds are completed and tagged properly □ □
Hot Burn Protective Clothing □ □ 100% Fall Protection complied (Toeboard/Toprail/Midrail) □ □
Appropriate Gloves □ □ Adequate number of Fire Extinguisher provided □ □
Hearing Protection □ □ Fire Blanket for welding, cutting/grinding work provided □ □
Respirotary Protection □ □ Open areas/gratings are covered and protected □ □
Full Body Harness □ □ Warning signs in place for preventing unauthorized access □ □
Rubber Boots □ □ Equipment inspected and correctly color coded □ □
□ □ Safety officer designated to the area □ □
Need of using ladder for □ □
working platform

Part 3: Acceptance (To Be Filled By JV HSE or PTW Coordinator)

JV Safety
Comment:

Reviewer Name: Date/Time: Signature: Tel:

Part 4: Issue and Validity (To Be Filled By JV Engineer or CM)

I am Aware of the conditions on this Permit, they have been discussed with the JHA and I confirm that the Safety Precautions as attached
to the Work Permit and certificates will be strictly observed. All personnel under My control shall be briefed through TBT accordingly.

Issuer Name: Date/Time: Signature: Tel:

Part 5: Close Out (To Be Filled By Holder and Reviewer)

The work is completed and working area has been cleared The site has been checked and working area accepted
from debris and equipment

Holder (Subcontractor Engineer or CM) Reviewer (JV HSE or PTW Coordinator)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 26/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (6) The Standard Permit To Work Forms (For Construction Area)

KARBALA REFINERY PROJECT

Night/Holiday WORK PERMIT

PTW No. :
Part 1: Work Details. (To Be Filled By Subcontractor Engineer or CM)

Application Date: Work Date: Company Type of Application

□ Night Work □ Holiday Work

Opened PTW No. Location Main Activity Time No. of Manpower

: ~ :
: ~ :
: ~ :
: ~ :
: ~ :
: ~ :
: ~ :
TOTAL

Part 2: Specific Safety Precaution. (To Be Filled By Subcontractor PTW Holder)

Preparation YES NO Safety Precaution YES NO

Safety Googles (Clear) □ □ Lighting & illumination on the Job site □ □

Face Shield □ □ Adequate illumination on access roads □ □
Hot Burn Protective Clothing □ □ First Aider available at each job activity (ratio 1 for every 100) □ □
Appropriate Gloves □ □ Adequate Supervision □ □
Hearing Protection □ □ Transportation Provided □ □
Respirotary Protection □ □ Tool Box Meeting Conducted □ □
Full Body Harness □ □ Assigned HSE Representative
Rubber Boots □ □ Name: Contact Number:

I certify that I have inspected the site and check all the safety requirements detailed in this permit are being fully
implemented and I confirmed that the area is safe for Night/Holiday work to start.

Represent Permit
Holder Name: Date/Time: Signature: Tel:

Part 3: Acceptance (To Be Filled By JV HSE or PTW Coordinator)

JV Safety
Comment:

Reviewer Name: Date/Time: Signature: Tel:

Part 4: Issue and Validity (To Be Filled By JV Superintendent or CM)

I am aware of the conditions on this Permit, they have been discussed with the JHA and I confirm that the Safety Precautions as
attached to the Work Permit and certificates will be strictly observed. All personnel under My control shall be briefed through TBM
accordingly.
Issuer Name: Date/Time: Signature: Tel:

Part 5: Close Out (To Be Filled By Holder and Reviewer)

The work is completed and working area has been cleared The site has been checked and working area accepted
from debris and equipment

Holder (Subcontractor Engineer or CM) Reviewer (JV HSE or PTW Coordinator)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 27/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (7) The Standard Permit To Work Forms (For Construction Area)
KARBALA REFINERY PROJECT

ROAD CLOSURE WORK PERMIT

PTW No. :
Part 1: Work Details. (To Be Filled By Subcontractor Engineer or CM)

Application Date: Start Date & Time: Completion Date & Time Company: Layout/Sketch attached
YES □ No □
Location : Reason for the Road Closure:

Describe Exactly
Work to be done:

Permit Holder Name: Date/Time: Signature: Tel:

Part 2: Specific Safety Precaution. (To Be Filled By Subcontractor PTW Holder or Safety)

Safety Precaution YES NO Identification of all affected organizion by Road Closure

Safe Detour Route provided □ □ Company Name Representative (Name/Sign)

Proper Signage for Detour □ □

Hard barrier with Proper Road Signs □ □
Appropriate Warning Signage in place □ □
Flagman / Traffic Controller available □ □
Blinker Lights for lights provided for night □ □
Official Request to SCOP PMC before 3 days required □ □
Medical Clinic & Ambulance driver notified □ □
Notification to all concerned □ □

Part 3: Acceptance (To Be Filled By JV HSE or PTW Coordinator)

JV Safety
Comment:

Reviewer Name: Date/Time: Signature: Tel:

Part 4: Issue and Validity (To Be Filled By JV Engineer or CM)

I am Aware of the conditions on this Permit, they have been discussed with the JHA and I confirm that the Safety Precautions as attached
to the Work Permit and certificates will be strictly observed. All personnel under My control shall be briefed through TBT accordingly.

Issuer Name: Date/Time: Signature: Tel:

Part 5: Close Out (To Be Filled By Holder and Reviewer)

The work is completed and working area has been cleared The site has been checked and working area accepted
from debris and equipment

Holder (Subcontractor Engineer or CM) Reviewer (JV HSE or PTW Coordinator)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 28/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (8) The Standard Permit To Work Forms (For Construction Area)
KARBALA REFINERY PROJECT

RADIOGRAPHY WORK PERMIT

PTW No. :
Part 1: Work Details. (To Be Filled By Subcontractor Engineer or CM)

Application Date: Start Date & Time: Completion Date & Time Company: JHA Attached:
YES □ No □
Location : Tools & Equipment to be Used Certificates Checked
Operators: YES □ N/A □

Equipment: YES □ N/A □

Describe Exactly
Work to be done:

Permit Holder Name: Date/Time: Signature: Tel:

Part 2: Specific Safety Precaution. (To Be Filled By Subcontractor PTW Holder or Safety)
Preparation YES NO Safety Precaution YES NO

Safety Googles □ □ Radiographers having a personal monitoring Dosimeter & Alarm □ □

Face Shield □ □ Appointed Radiation Protection Supervisor(RPS) performed □ □
Hot Burn Protective Clothing □ □ Controlled area barricaded and radiation warning signs posted □ □
Appropriate Gloves □ □ Sufficient illiumination at walkways and Radiography area □ □
Hearing Protection □ □ Safe Work platform for work □ □
Respirotary Protection □ □ Flash light placed night time for preventing unauthorized access □ □
Full Body Harness □ □ Remote handling Equipment i.e. Tongs available □ □
Rubber Boots □ □ Radioactive sources stored inside adequately shielded storage □ □
Special Radiation PPE for All □ □

Part 3: Acceptance (To Be Filled By JV HSE or PTW Coordinator)

JV Safety
Comment:

Reviewer Name: Date/Time: Signature: Tel:

Part 4: Issue and Validity (To Be Filled By JV Engineer or CM)

I am Aware of the conditions on this Permit, they have been discussed with the JHA and I confirm that the Safety Precautions as attached
to the Work Permit and certificates will be strictly observed. All personnel under My control shall be briefed through TBT accordingly.

Issuer Name: Date/Time: Signature: Tel:

Part 5: Close Out (To Be Filled By Holder and Reviewer)

The work is completed and working area has been cleared The site has been checked and working area accepted
from debris and equipment

Holder (Subcontractor Engineer or CM) Reviewer (JV HSE or PTW Coordinator)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 29/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (9) The Standard Permit To Work Forms (For Construction Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 30/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.2] (10) The Standard Permit To Work Forms (For Construction Area)

KARBALA REFINERY PROJECT

GRATING REMOVAL WORK PERMIT

PTW No. :
Part 1: Work Details. (To Be Filled By Subcontractor Engineer or CM)

Application Date: Start Date & Time: Completion Date & Time Company: Layout/Sketch attached
YES □ No □

Location : Reason for Grating Removal: JHA Attached:

YES □ No □

Describe Exactly
Work to be done:

Permit Holder Name: Date/Time: Signature: Tel:

Part 2: Specific Safety Precaution. (To Be Filled By Subcontractor PTW Holder or Safety)

Preparation YES NO Safety Precaution YES NO

Safety Googles □ □ Use of correct tools & tackles □ □

Face Shield □ □ Temporary Hard Barricades or Cover □ □
Hot Burn Protective Clothing □ □ Caution sign all sides for preventing unauthorized access □ □
Appropriate Gloves □ □ No loose materials on the floor □ □
Hearing Protection □ □ Life line / Anchorage □ □
Respirotary Protection □ □ Scaffold tag system in place □ □
Full Body Harness □ □ Sufficient Replacement Clips- Available □ □
Rubber Boots □ □ Trained Grating Removal Personnel and Supervision □ □
□ □ "OPEN HOLE-DANGER, DO NOT REMOVE"caution board in place□ □

Part 3: Acceptance (To Be Filled By JV HSE or PTW Coordinator)

JV Safety
Comment:

Reviewer Name: Date/Time: Signature: Tel:

Part 4: Issue and Validity (To Be Filled By JV Engineer or CM)

I am Aware of the conditions on this Permit, they have been discussed with the JHA and I confirm that the Safety Precautions as attached
to the Work Permit and certificates will be strictly observed. All personnel under My control shall be briefed through TBM accordingly.

Issuer Name: Date/Time: Signature: Tel:

Part 5: Close Out (To Be Filled By Holder and Reviewer)

The work is completed and working area has been cleared The site has been checked and working area accepted
from debris and equipment

Holder (Subcontractor Engineer or CM) Reviewer (JV HSE or PTW Coordinator)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 31/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.3] Revalidation Sheet (For Construction Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 32/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.4] (1) The Standard Permit To Work Forms (For Commissioning Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 33/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.4] (2) The Standard Permit To Work Forms (For Commissioning Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 34/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.4] (3) The Standard Permit To Work Forms (For Commissioning Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 35/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.4] (4) The Standard Permit To Work Forms (For Commissioning Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 36/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.4] (5) The Standard Permit To Work Forms (For Commissioning Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 37/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.4] (6) The Standard Permit To Work Forms (For Commissioning Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 38/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.4] (7) The Standard Permit To Work Forms (For Commissioning Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 39/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.4] (8) The Standard Permit To Work Forms (For Commissioning Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 40/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.5] Revalidation sheet (For Commissioning Area)

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ

 PROJECT PROCEDURE

PERMIT TO WORK
DOC. NO. : IONE-AA00-PE-HS-0012
KARBALA REFINERY PROJECT Rev. 5 Page 41/41
Ref. FEED DOC. No. : 2342-AA00-JSM-701

[Appendices 7.6] Identification of Authorized Personnel and Alternates

Karbala Refinery Project

Identification of Authorized Personnel & Alternates

Project Unit: Location: Effective Date: Rev.:

Authorized Person Alternate
Position Name Signature Badge No Name Signature Badge No

HDGSK JV  35km Southern Strategic Road, KARBALA City, IRAQ