LPRC SITE
WORK PERMIT FOR HOT WORK / ENTRY TO CONFINED
SPACE
Sl. No. __________
Work clearance from __________ hrs. of date __________ To __________ hrs. of
date __________ (Valid for the shift unless renewed)
Issued to (Department / Section / Contractor)
____________________________________________________________
Exact Location of work (Area / Unit / Equipment no. etc.)
____________________________________________________________
Description of work
___________________________________________________________________________
_____
___________________________________________________________________________
_____
____________________
THE FOLLOWING ITEMS SHALL BE CHECKED BEFORE ISSUING THE PERMIT
(Tick mark in the appropriate box. Checklist items marked with asterisk (*)
shall be complied by receiver)
Sr. Item Done Not Sr. Item Done Not
No. Reqd. No. Reqd.
A General points B For Hot work / Entry to
confined Space
1 Equipment / Work Area inspected 1 Proper ventilation and Lighting
providing
2 Surrounding area checked, 2 Proper means of exit / escape
cleaned and covered provided
3 Sewers, manholes, CBD etc. and 3 Standby personnel provided from
hot surfaces nearby covered Process / Maint. / Contractor / Fire
/ Safety dept.
4 Considered hazard from other 4 Checked for oil and Gas trapped
operations and concerned behind the lining in Equipment
persons alerted.
5 Equipment blinded / disconnected 5* Shield provided against spark
/ closed / isolated / wedge
opened
6 Equipment properly drained and 6* Portable equipment / nozzles
depressurized properly grounded
7 Equipment properly steamed / 7* Standby persons provided for
purged entry to confined space
8 Equipment water flushed
9 Iron sulfide removed / kept wet C For Vehicle Entry
10 Equipment electrically isolated 1* Spark Arrestor on the mobile
and tagged vide permit no. equipment / vehicle provided.
11 Gas test:
HCs = __________ %LEL
Toxic gas = __________ ppm, O 2 =
__________ %
12* Running water hose / Fire D For Excavation works
extinguisher provided. Fire water
system available.
13* Area cordoned off and 1 Clearance obtained for
Precautionary tags / Boards excavation / road cutting / Dyke
provided. cutting from concerned depart.
REMARKS:
1. The activity has the following expected residual hazards (Tick the
relevant items): Lack of Oxygen / H2S, Toxic Gases / Combustible gases
/ Pyrophoric Iron / Corrosive Chemicals / Steam – Condensate / Others
2. Following PPEs to be used in addition to standards PPEs (Helmet, Safety
Shoes, Hand gloves, Boiler suit): Face Shield / Apron / Goggles / Dust
Respirator / Fresh Air Mask / Lifeline / Safety Belt / Airline / Earmuff etc.
3. Additional precautions if any:
____________________________________________________________
______________________________________________________________________
______________________________________________________________________
__________
Issuer Name & Designation Issuer Signature Receiver Name and Receiver Signature
Designation
Clearance renewal
Date Time Gas Test Values Additional precautions if Issuer’s Name, Receiver Name,
for HC’s, Toxic, O2 any. Otherwise mention Designation & Designation and
From To
etc. “NIL” Signature Signature
Closing of the work permit:
Receiver: Certified that the subject work has been Issuer: Verified that the job has been completed and area
completed / stopped and area cleaned. cleaned and is safe from any hazard.
Date & Time Name & Designation Signature Date & Time Name & Designation Signature
General Instructions:
1. The work permit shall be filled up carefully and accurately in clear
handwriting ensuring that complete information is provided in all
sections / subsections and none of column is left blank. Sketches
should be provided wherever possible to avoid miscommunication.
2. Appropriate safe-guards and required personnel protective equipment
shall be determined by a careful analysis of the potential hazards and
the operations to be performed prior to starting the work.
3. In case of fire alarm / siren, all work must immediately be stopped.
4. Only certified vehicle / engines and permitted type of electrical
equipment and tools are allowed in operating areas.
5. Welding machines should be located in non-hazardous and ventilated
areas.
6. No hot work should be permitted unless the explosive meter reading is
Zero.
7. When a person is entering confined space, the receiver must keep
minimum two standby-designated persons at the manhole or entry
point.
8. Before box up of any vessel manhole cover, ensure that no men /
materials are inside the vessel.
9. For renewal of work clearance, the issuer shall ensure that the
conditions are satisfactory for the work to continue. If the conditions
have changed, it may be necessary to issue a new permit or amend the
existing permit.
10. This clearance on the same permit can be renewed / extended upto a
maximum of seven calendar days.
11. This permit must be available at work site at all times.
12. On completion of the work, the permit must be closed and kept as
record.
13. The industry may add other relevant instructions based on their
operating and maintenance practices.
ANNEXURE II
LPRC SITE
COLD WORK PERMIT
Sl. No. __________
Work clearance from __________ hrs. of date __________ To __________ hrs. of
date __________ (Valid for the shift unless renewed)
Issued to (Department / Section / Contractor)
____________________________________________________________
Exact Location of work (Area / Unit / Equipment no. etc.)
____________________________________________________________
Description of work
___________________________________________________________________________
_____
___________________________________________________________________________
_____
THE FOLLOWING ITEMS SHALL BE CHECKED BEFORE ISSUING THE PERMIT
(Tick mark in the appropriate box. Checklist items marked with asterisk (*)
shall be complied by receiver)
Sr. Item Done Not Sr. Item Done Not
No. Reqd. No. Reqd.
1 Equipment / Work Area inspected 6 Equipment water flushed
2 Surrounding area checked, 7 Equipment properly steamed /
cleaned and covered purged
3 Equipment blinded / disconnected 8 Proper ventilation and lighting
/ closed / isolated / wedge provided
opened
4 Equipment properly drained and 9 Area cordoned off & caution
depressurized boards / tags provided.
5 Equipment electrically isolated 10 Gas test:
and tagged vide Permit no.
____________________ HCs / Toxic etc.
HCs = __________ %LEL
Toxic gas = __________ ppm
Remarks:
1. The activity has the following expected residual hazards (Tick the
relevant items): Lack of Oxygen / H2S, Toxic Gases / Combustible gases
/ Pyrophoric Iron / Corrosive Chemicals / Steam – Condensate / Others
____________________
2. Following additional PPE to be used in addition to standards PPE
(Helmet, Safety Shoes, Hand gloves, Boiler suit): Face Shield / Apron /
Goggles / Dust Respirator / Fresh Air Mask / Lifeline / Safety Belt /
Airline / Earmuff etc.
Additional precaution if any:
Issuer Name & Designation Issuer Signature Receiver Name and Receiver Signature
Designation
Closing of the work permit:
Receiver: Certified that the subject work has been Issuer: Verified that the job has been completed and area
completed / stopped and area cleaned. cleaned and is safe from any hazard.
Date & Time Name & Designation Signature Date & Time Name & Designation Signature
Clearance renewal
Date Time Additional precautions if any. Issuer’s Name, Receiver Name,
Otherwise mention “NIL” Designation & Designation and
From To
Signature Signature
General Instructions:
1. The work permit shall be filled up carefully and accurately in clear
handwriting ensuring that complete information is provided in all the
sections / subsections. Sketches should be provided wherever possible
to avoid miscommunication.
2. Appropriate safe-guards and required personnel protective equipment
(PPEs) shall be determined by a careful analysis of the potential
hazards and the operations to be performed prior to starting the work.
3. Requirement of standby personnel from Process / Maintenance /
Contractor / Fire / Safety etc. if any shall be mentioned in the additional
requirement.
4. In case of fire alarm / siren, all work must immediately be stopped.
5. For renewal of work clearance, the issuer shall ensure that the
conditions are satisfactory for the work to continue. If the conditions
have changed, it may be necessary to issue a new permit or amend the
existing permit.
6. This clearance on the same permit can be renewed / extended upto a
maximum of seven calendar days.
7. This permit must be available at work site at all times.
8. On completion of the work, the permit shall be closed.
The industry may add other relevant instruction based on their
operating and maintenance practices.
ANNEXURE III
CONEX PST
ELECTRICAL ISOLATION / ENERGISATION PERMIT
Section-A: Isolation Sl. No.
Permit.
Request for Isolation:
Date: ____________________ Time: ____________________
Department / Section / Area issuing the permit
____________________________________________________________
Equipment number to be isolated:
____________________________________________________________
Name of the equipment / circuit to be isolated:
____________________________________________________________
The above-mentioned equipment / circuit shall be de-energized and
isolated from all live conductors to carry out the maintenance work by
____________________ section / for operational requirement.
Issuer Name Designation Signature
Certificate of Isolation:
Date: ____________________ Time: ____________________
Certified that Equipment / Circuit no. ____________________ of
____________________ plant has been electrically isolated by switches /
isolators / links / fuses (tick as applicable) and the danger tag is put on the
supply panel. Actions in respect of electrical isolation have been recorded
in the electrical shift logbook.
Name of Authorized Designation Signature
Person
Section-B: Energizing Sl. No.
Permit.
Request for Energizing:
Date: ____________________ Time: ____________________
Department / Section / Area issuing the permit
____________________________________________________________
Equipment number to be energized:
____________________________________________________________
Name of the equipment / circuit to be energized:
____________________________________________________________
Work on the above mention equipment / circuit has been completed and
all the applicable permits closed. This equipment / circuit may be
energized.
Issuer Name Designation Signature
Certificate of Energizing:
Date: ____________________ Time: ____________________
Certified that Equipment / circuit no. ____________________ of
____________________ plant has been electrically energized, and the danger
tag removed from the supply panel. This is also recorded in the electrical
shift logbook.
Name of Authorized Designation Signature
Person
ANNEXURE IV
GENERAL PERSONAL PROTECTIVE EQUIPMENTS
Type of PPEs Remarks
Protection
Head Hard hat / Helmet - meets ANSI Z89.1 Name should be displayed for
requirements. identification
Eye & face Safety Glass – meets ANSI Z87 Person wearing prescription glass
requirements to wear over the glass
Foot Steel toed shoe / boot Tennis shoe, sandals not allowed
High Visibility Attire Vest with high visibility- meets ANSI Welders excluded
reflectivity requirements
Hand / Finger Appropriate Gloves People using tools / materials to
use always
Hearing Ear plug- used for noise more than 85 Exposure not to exceed 140 dBA
dBA
ACTIVITY BASED EYE / FACE PROTECTIVE EQUIPMENTS:
Activity Safety Equipment
Welding Welding Hood and safety glasses with side shields
Burning Burning Goggles with Shield
Abrasive grinding or Face Shield and safety glasses with side shields
cutting
Drilling Goggles or Face Shield and safety glasses with side
shields
Reaming Face Shield and safety glasses with side shields
Chemical Handling Goggles and Face Shield
Molten Materials Goggles and Face Shield
Corrosive Liquids Goggles and Face Shield
Concrete Pouring Safety glasses with side shields
ACTIVITY BASED PROTECTION EQUIPMENTS
Activity Safety Equipment Remarks / Protection System
Vessel / Confined Space Self-Contained Breathing Gas / Oxygen / H2S test to be checked,
Entry Apparatus Adequate Ventilation & Illumination
Working at height / Safety harness / Safety Protection fall arrest system / Proper
Operating Mobile plant belt guard rail / scaffolding / safety netting /
certified mobile Boom Lift / Crane /
Excavator / Front Loader / Dumper,
ladder / 2 M rule adherence
Excavation Self-Contained Breathing Shoring, Benching, Using shield, 1.5 M
Apparatus, Life-Line - as depth Rule adherence / Proper entry -
needed exit
FALL PROTECTION SYSTEM
Personal fall Arrest System:
o Means a system used to arrest an employee in a fall from a working
level.
o System consists of an anchorage, connectors, a body harness and
may include a lanyard, deceleration device, lifeline or suitable
combination of these.
Positioning Device:
o Means a body belt or body harness rigged to allow an employee to
be supported on an elevated, vertical surface, such as a wall or
column and work with both hands free while leaning.
SAFETY NET
FALL ARRESTER
Beamer, Glyder, Girder Grip:
LADDER:
A minimum of 1-meter overlap is required between ladders
Secure at the top where possible
Area around ladder cordoned off, to keep the public safe.
Extend ladder 1m (3 rungs) above landing place
Follow the 4:1 rule when using extension ladders
LANYARDS / RETRACTABLE LANYARDS:
2 Lanyards Minimum for 100% FP
MOBILE ELEVATED WORKING PLATFORMS:
(MEWPs) are used to provide temporary access for people or equipment to
inaccessible areas, usually at height. There are two distinct types of
mechanized access platforms which are known as a “scissor lift” or a
“cherry picker”. They are designed to lift personnel and equipment of
limited weights (usually less than a ton, although some have a higher safe
working load (SWL). They are usually capable of being fully (including
setup) by a single person.
Figure: MEWPS: SCISSORS LIFT AND CHERRY PICKET
ANNEXURE V
WORKING SAFELY AT HEIGHTS CHECKLIST
For working at a height of 2 M or more
Check Yes No N/A
Where relevant, working at heights is part of induction
People working at heights have been given information,
instruction and training
Workers are supervised to ensure that safe work
practices are in place
Work areas are clear of protruding objects, water,
vehicles and people
Hand-rails on stairs are secure and steps are well
maintained
All work areas are free from obstructions
Walkways, corridors and stairs are free from
obstructions
Ladders are in good condition and are secure and fixed
firmly in place
High ladders have fall-back protection
Mechanical lifts are safe
Mezzanine floors have safe access and fall protection,
such as hand-rails
Fall arrest systems, such as harnesses are in place
Safer, alternative ways to do the work have been
considered
Potential existing hazards have been identified
The risks of anyone falling from heights have been
assessed
Practical steps have been taken to prevent falls
