Permit to Work on Pipelines and Pressure Vessels

M.V./S.S.: POSITION /PORT Page 1 of 3
VALID FOR FROM hrs DATE:
PERIOD * TO hrs DATE:
Specific Location and Description of work:
Special Conditions: (If any)
Personnel assigned to the work:
We, the undersigned, are satisfied that the checklist on pages 2 and 3 has been completed correctly and that it is safe for the work to commence.
Officer in Charge Signature:
Chief Engineer’s Signature :  
Master’s Signature:
Permit Cancellation:
To be signed by an officer when the work is completed or cancelled. +
Officer in Charge Signature:  
Date: Time:
* Valid only for time of work, not to exceed 8 hours.
+ Delete as appropriate.

 

M.V./S.S.: CHECKLIST Page 2 of 3
YES NO REMARKS
PART 1
1.0 Have all persons been briefed on
the requirements of the work?
2.0 Are all persons competent to carry
out the work?
3.0 Have all personnel been provided
with the Personal Protective
Equipment necessary for the task
being undertaken?
4.0 Are Isolation Valves secured or
locked in closed position and
suitably labelled to prevent thembeing inadvertantly opened?
5.0 Is the part of the system  to be
Worked upon effectively isolated by
Closing the appropriate valves
6.0 Have personnel been instructed to
slacken Nuts and Bolts slowly before
breaking the joint, not to remove
Bolts completely, and to stand clear
of the path that will be followed bythe release of any residual pressurein the system
7.0 Has pressure been bled off the part
of the system to be worked on by
opening Drain Cocks or Vents as
appropriate and ensuring that
pressure remains off?
8.0 Has a copy of this Permit been
posted at the place of work?  If the
vessel is a Chemical or Gas Carrier,
also complete part 2.
9.0 Have all Valves and Pipes been
re-secured properly on completion
of the work?
Chief Engineer’s Signature:

 

 

M.V./S.S.: CHECKLIST Page 3 of 3
YES NO REMARKS
PART 2 CHEMICAL/GAS CARRIERS
10.0 Has the section of pipe or vessel to
be worked upon been purged with
inert gas or Nitrogen?
11.0 Have precautions been taken to
avoid the hazards of Static
Electricity particularly when
removing components?
12.0 Have precautions to avoid Toxic
Vapour Emission Release or
Inhalation been taken?
13.0 Are the equipment tested/calibrated prior use
Chief Officer’s Signature:
                                Date/time:
 

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