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Cold Work Permit

Cold Work Permit

M.V./S.S.: POSITION/ PORT
 Location, Description of Work and Equipment to be used: 

 

Condition of Area / Space/Work Activity
Section 1 – Preparation and checks to be carried out by the Senior Officer in Charge of Cold Work.
Yes No  Remarks
1.1 The Equipment/Pipeline has been
prepared as follows:
Vented to Atmosphere
Washed
Drained
Purged
Other
1.2 The Equipment/Pipeline has been
Isolated as follows:
Lines Blanked
Valves Closed
Lines Disconnected
Other
1.3 Is Equipment free from:
Oil
Pressure
Gas
H 2 S
Steam
1.4 Is surrounding area free from Hazards?
1.5 If work is to be performed on
Electrical Equipment, has that
equipment been Isolated?
1.6 Has risk removed carried out

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M.V./S.S.: POSITION
VALID FOR FROM hrs DATE:
PERIOD * TO hrs DATE:
Section 2 – Information and instructions to person carrying out cold work.
The following Personal Protections must be worn: (spacify)
Equipment/Pipeline contained following material in service:
Equipment expected to contain the following Hazardous Material when opened:
Special Conditions/Precautions:
In the circumstances noted, it is considered safe to proceed with this cold work.
Senior Officer in Charge Signature:
Master’s Signature:
Section 3 – The Coldwork has been completed and all Persons under my supervision, Materials and Equipment have been withdrawn.
 
Senior Officer in charge Signature:  
 
Date   Time  

*  Valid only for time of work, not to exceed 8 hours.
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