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: | |||||||||||||||