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Permit To Work

This document outlines roles and responsibilities for permit to work procedures. It describes roles for the CEO, division presidents, HSE managers, chief risk officer, HSE engineer, issuing authority, and area authority. The CEO oversees compliance, while division heads implement guidelines. HSE managers communicate requirements and audit compliance. The issuing authority reviews and issues permits, and the area authority monitors on-site controls.

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0% found this document useful (0 votes)

345 views53 pages

Permit To Work

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shabirahsan79

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You are on page 1/ 53

Doc No: HSE/SOP-29

Rev: 00
PERMIT TO WORK Date of Rev: June 22, 2016
Page: 2 of 33

Document Revision/Review History

REVISION REVIEW Reviewed by

No. Date Description No. Date

00 Development of procedure as
22-06-2016 per the requirement of HSE MS C
revamping task

This document is the Intellectual Property of Descon Engineering Limited. Any unauthorized use, including the modification
and reproduction of the content is strictly prohibited. © Copyrights Ordinance 2002, All Rights Reserved.
Doc No: HSE/SOP-29
Rev: 00
PERMIT TO WORK Date of Rev: June 22, 2016
Page: 3 of 33

Table of Contents

1. OBJECTIVES: ..................................................................................................... 4

2. SCOPE: ............................................................................................................... 4

3. ROLES AND RESPONSIBILITIES: ..................................................................... 4

4. ABBREVIATIONS / DEFINITIONS: ..................................................................... 9

5. PROCEDURE:................................................................................................... 13

5.1 Permit to Work (PTW): ................................................................................... 13

5.2 Activity Flow and Form Completion: ............................................................... 18

5.3 Certificates: .................................................................................................... 22

6. TRAINING AND AWARENESS: ........................................................................ 32

7. REFERENCE & RELATED DOCUMENTS:....................................................... 32

1. OBJECTIVES:
This procedure shall provide the guidelines for the adequate implementation of
formalized mechanism (Permit to work) to assess and control work place hazards /
risks by providing the management controls over the planned activities which have
hazardous interactions.

2. SCOPE:
This procedure shall be applicable and adhered at DESCON Headquarter, Divisions /
Business Units and on all its Project sites.

3. ROLES AND RESPONSIBILITIES:

Chief Executive Officer

x Shall be owner of this document and overview the compliance of guidelines and
fulfillment of expectations outlined in this procedure.

Divisional Presidents / Head Business Units / Project Managers / Site Managers

x Shall be responsible for the implementation of all the details given in this
procedure wherever they are applicable in their respective areas of influence.
x Shall ensure availability of all resources required for the compliance of the details
given in this document and shall participate in compliance audits.
x Business Unit Head shall be responsible for providing authorization for the
exemption against the fulfillment of any of the requirement of this document for a
specific period of time under particular conditions giving details of controls put in
place for that period in consultation with HSE Manager on Exemption format.

Division Head HSE/ HSE Manager Business Unit / Site HSE Manager or In-charge

x Shall be responsible for adequate communication, trainings and compliance

audits along with advising to fill the gaps identified in implementation of the
requirements as details given in this procedure.
x Shall be responsible for review of this procedure as per set frequency or on need
basis.

Chief Risk & Compliance Officer

x Shall coordinate for the revision of this document as per set frequency or as and
when needed.
x Shall be responsible for conducting the compliance audits of this procedure

HSE Engineer shall be responsible for,

x Communicating the requirements laid down in this recommendation to all
employees and contractors.
x Performing on-spot PTW checks/Inspections/audits.

x Monitoring and tracking the close-out of actions items generated as a result of

PTW audits.
x Delivering PTW System training to all relevant employees and contractors.
x Providing PTW training to site new employees and contractors, including refresher
training to all site personnel.
x Keeping the list of authorized PTW personnel up to date

Issuing Authority shall be responsible for

x Reviewing and issuing the Permits.

x Ensuring the PTW forms and all required associated documentation are filled out
clearly and accurately.
x Ensuring the Performing Authority is skilled and competent to complete the work.
x Making sure interacting jobs are identified and cross referenced.
x Suspending or re-planning any conflicting works.
x Checking compliance with the scope and timing of work detailed on a PTW.
x Identification of all hazards associated with the works, together with the Permit
Requester, Performing Authority and Area HSE Engineer/Officer.
x Describing the required PPE’s.
x Ensuring the Performing Authority is aware of and understands all conditions and
precautions specified on the PTW.
x Ensuring Performing Authority is aware of what to do in the event of an emergency
or the suspension of a PTW.
x Ensuring copies of all current Permits to Work are displayed on site and at the
Permit Issue Point.
x Ensuring handovers from shift to shift and crew to crew are effective.
x Notifying the Approving Authority of planned, completed and suspended work, as
required by a PTW system.
x Ensuring they do not approve a PTW for themselves.

Area Authority shall be responsible for

x The control (via continuous monitoring and supervision) of the location where
work(s) is (are) carried out.
x To make sure on site that all controls specified in the Permit and associated
documents are implemented and will remain in place until the job is complete.
x To confirm necessary process isolation, depressurizing, Lock Out/Tag Out of
valves or equipment is complete before work can commence under an Isolation
Certificate.

x Ensuring that all Electrical/Mechanical/Process Isolation procedures are followed;

and that all applicable Certificates are signed.
x To confirm all PPE’s required for job.
x Giving final authorization of work commencement at site. He shall immediately
inform Issuing.
x Authority (by radio/phone etc.) the time of start of job.
x Providing leadership as a supervisor and stopping work if they or the Work Party
believe a safety issue needs to be resolved.
x Supervision of all Permits in his area.
x Checking the worksite is inspected prior to the resumption of work after a PTW has
been suspended.
x Ensuring proper shift change and PTW revalidation.
x Inspecting the worksite to ensure it has been returned to the normal operating
status and has been left in a safe state when the work is complete.

Performing Authority shall be responsible for

x Preparing, together with the Permit Requester (they can be the same person), the
PTW.
x Understanding the conditions under which the work is to be performed.
x Ensuring that the work precautions have been carried out and confirming that the
equipment preparation is appropriate for the activity proposed.
x Ensuring all the Work Party are aware of, and understand the scope, hazards,
precautions and mitigations stipulated on a PTW.
x Providing leadership as a supervisor and stopping work if he or the Work Party
believes a safety issue needs to be resolved or the situation changes.
x To left the site in safe and tidy condition, after completion of job.
x Of the Safe work execution,
x Ensuring full involvement in the work preparation process.
x Fulfillment of all the requirements of Permit and certificates.

The Work Party is the group of people (i.e. company employees / sub-contractor
personnel) who are responsible for.

x Understanding of the PTW system as it specifically applies to their job.

x Ensuring that work requiring a PTW does not commence until the PTW is
authorized and issued.
x Understanding the precautions and conditions detailed on a PTW, prior to
commencing work and ensuring that they are in place and/or strictly followed.
x Stopping work, making the area safe and reporting to the supervisor when worksite
conditions change.

x Providing leadership as individuals and stopping work if they or others in the Work
Party believe a safety issue needs to be resolved.

The Isolation Authority shall be responsible for:

x Ensuring that all sources of energy that need to be isolated are identified.
x Ensuring that each isolation point required is identified
x Ensuring all points of isolation/separation/blinding etc. are marked up on drawings
and numbered and correspond with the Isolation Certificate.
x Ensuring that the correct method of isolation for each point is identified.
x Performing the isolation, ensuring that trapped energy and residues are safely
dissipated.
x Issuing and signing the Isolation Certificate.
x A specific knowledge and understanding of the PTW system as it applies to the
relevant isolations being performed.
x Understanding the PTW system and the relevant Certificates as they specifically
apply to their job.
x Understanding the precautions and mitigations prior to commencing the isolation
and ensuring that they are strictly followed.
x Removing isolation on the completion of the work as permit closure.

An Authorized Gas Tester (AGT) shall be responsible for

x The minimum number of samples to take, their location and what to test for is
clearly defined on the PTW and Confined Space entry certificate. It is the
responsibility of the Issuing Authority to define these parameters.
x Gas tests are done before work starts and at the frequency stated on the Permit.
An extra test is done before work restarts if the worksite is left unattended for more
than an hour.
x The first gas testing is done as close to the commencement of work as possible.
x Results of the gas testing are recorded and timed, and entered on the Permit and
Confined Space entry certificate.
x To suspend the job in the event that any gas level changes during the work.

Remark: For work for which continuous gas monitoring is required, a member of the
Work Party may be responsible for gas measurements, without being appointed as
Authorized Gas Tester. He must, however, have been trained in the use of the gas
detector and any actions that may be taken.

Confined Space Attendant shall be responsible for:

x Knowing the hazards related with specific confined space.

x Ensuring that only authorized personnel will go inside confined space.

x Adequate communication with confined space entrants, area authority and
Emergency response Team.
x Adequately maintain in/out Log of Entrants.
x Knowing the emergency response plan and procedure.
x Having emergency contact numbers or nearest location of manual call points.

Firewatchers shall be responsible for:

x Knowing the emergency response plan and procedure.

x Having emergency contact numbers or nearest location of manual call points.
x Operating and use the fire extinguisher provided, or how to turn on the water hose
and nozzle provided.

Remark: Work for which Firewatcher is required, a member of the Work Party may
be responsible for Firewatcher position. He must, however, have been trained in the
use of the Fire extinguishers and any actions that may be taken.

Radiation Protection Officer shall be responsible

x To check the Pocket Dosimeter for individual Radiographer

x To check the film badge for individual Radiographer
x To check the Collimator against standard certificate that reduces the safe
barricaded area
x To check the function of warning lights and film viewer and their performance is
verified by Electrical Section
x To check Survey meter of RT contractor and validity of its calibration certificate.
x To check the function of the Crank Cable and condition of the guide Tube
x To check the MSDS of all chemicals to be used for processing of RT films and it is
endorsed by relevant sections
x To check the safety holder and lead material sheet for handling emergency
situation in case of source stuck in the guide tube
x To check the Mega Phone for PA announcement around the barricaded area by
contractor safety person
x To check the radiation leakage by Survey Meter.
x To check the barricade Tape / rope enough in quantity to barricade the safe area
against sources strength.
x To check the calculation of the safe area distance according to inverse square law.

4. ABBREVIATIONS / DEFINITIONS:
Cold Work
Any work that does not produce any actual or potential source of ignition such as civil
works, cable terminations, bolt tightening, removal of chokes, glands from valves,
opening of machinery, painting & insulation jobs piping / structure /tank at a facility,
etc.

Competent Person
Is a person, because of his knowledge, training and experience, is qualified to perform
certain duties safely and correctly.

Confined Space
Means a space that:

Is large enough and so configured that an employee can bodily enter and perform
assigned work; and
Has limited or restricted means for entry or exit (for example, tanks, vessels, silos,
storage bins, hoppers, vaults, and pits are spaces that may have limited means of
entry.); and
Is not intended for continuous operation or human presence and has temperature limit
for entry.
Excavation > 1.5m is also considered as confined space or more stringent rules from
client will be followed.

Confined Space Entry Certificate

For any work involving the need to enter into a confined space, the Confined Space
Entry Certificate shall be used.

De-Isolation for Testing Certificate

Any work involving the need to de-isolate plant and equipment for test / checking
purpose on this certificate under specified procedure (DTC). This will not close the
Isolation Certificate but suspend it for the period of DTC validation.

Energy Isolation
The procedure for installing a mechanical device that physically prevents the release
of hazardous energy (e.g. electrical, mechanical, hydraulic, pneumatic, chemical,
thermal) during works / commissioning or maintenance of plant and equipment.

Hazardous Area
An area within a restricted area where there is a possibility of explosive gas and air
mixture, hydrocarbon liquid, where uncontrolled use of a flame or heat-producing work
has the potential for fire and/or explosion, oxygen deficient or presence of hydrogen
sulphide (H2S) where special precautions are required before commencement of work.

Hot Work

Any work where there is a potential of flame or spark such as in welding,

burning/cutting, grinding, drilling, chipping, sand blasting etc.

Isolation Certificate
For any work involving the need to isolate plant and equipment to protect against
hazards of the system or process, the isolation certificate shall be used. This is used
for all energy isolations (electrical, mechanical, process, pneumatic, hydraulic,
chemical and thermal). This is to ensure all energy isolation sources are isolated prior
to the commencement of work; all energy isolation activity is effectively communicated
to all affected personnel and that proper management controls are maintained on
energy isolation devices.

Excavation Certificate
For any work that entails breaking of ground or cutting in to floors below the
surrounding level excavation certificate shall be used. A confined space also applies to
excavations greater than (5 feet) in depth.

Radiography Certificate
This certificate is required for any work involving radiography. This is to prevent
exposure to the radioactive substances to the personnel.

Issuing Authority
Issuing Authority reviews and issues Permits and is in charge of the consolidation of
all the documents needed for the PTW (P&IDs, SLDs, Procedure, Associated Permit
and Certificates, etc.). He can be assisted in this task by a Supervisor.

Area Authority
The Area Authority is responsible for the location where the work is taking place,
generally nominated area Engineer. The Area Authority confirms on site that all
controls specified in the Permit and associated documents are in place. This role can
be fulfilled by the Issuing Authority provided they check the work site.
They are typically a nominated Area Supervisor, or Area Engineer.

This role can be fulfilled by the Issuing Authority, provided he checks the work site

Performing Authority / Permit Holder

Is the person who supervises the work being carried out as described in a PTW; it may
also be an individual carrying out the work. Only competent (i.e. trained and
authorized) persons shall be appointed to this position.

Sub Contractor’s Authorized Person

The Sub Contractor nominated person will be declared competent by HSE Department
after the person qualifies the PTW assessment test.

Fire Watch Man

Is a person assigned to monitor the risk of fire associated with the nature of the job
(hot work) being performed and should be trained in hazards associated with the work,
and is able to take action for containment. He must be able to use the fire
extinguishers.

Authorized Gas Tester

Person trained & certified by Project Manager / site manager or his authorized
competent person in checking and use of gas tester, he should be able to interpret the
result of gas testing equipment & should be conversant with explosive & toxic range of
gases/ vapors and also should be conversant with the limitation of the specific
equipment being used for gas testing.

Electrical Isolation Authority

An authorized and competent person, typically an electrical technician, formally
authorized by the Site Manager or his designee responsible for ensuring the correct
specification, isolation, de-isolation and documentation of Electrical Isolations required
in support of individual Work Permits

Radiation Protection Officer

Person as delegated by the Site Manager, who has been trained to verify Radiography
Certificates & checklist

Job Safety Analysis (JSA)

A Job Safety Analysis is a method that can be used to identify, analyze and record 1)
the steps involved in performing a specific job, 2) the existing or potential safety,
environment, security and health hazards associated with each step, and 3) the
recommended action(s) / procedure(s) that will eliminate or reduce these hazards to
an acceptable risk level.

Heavy Lift Certificate

A Heavy Lifting certificate shall be obtained for jobs involving moving/lifting of heavy
loads (1 Ton and above), Lifting over live process equipment, lifting involving two or
more lifting/pulling appliances, lifting requiring rollers, or guide frame/structure.

Lock-Out / Tag-Out
In energy isolation, the use of a padlock or similar device to hold an energy isolating
device in the safe position and prevent the energizing of a machine or equipment.
Where locks cannot be used, a prominent warning device, such as a tag and a means
of attachment, is fastened to an energy isolating device to indicate that the energy
isolating device and the equipment being controlled may not be operated until the tag
out device is removed.

Master Control Sheet

Multiple Permits (two or more than two) issued for work on specific equipment shall be
recorded in Master Control Sheet and cross-referenced clearly in PTW. Each master
control sheet will have a unique number.

Non-routine Work
All activities, which are outside the regular operation of the facility. Non-routine Work is
not normally covered by a Management System procedure or work instruction, unless
procedures and work instructions stipulate the use of a permit.

Routine Work
Routine work does not require a permit and is covered by a Management System
procedure or work instruction

PTW Exemption List

A list of simple routine tasks of short duration that have been jointly agreed by the
Project manager/ Site Manager and HSE Manager that do not require a PTW.

Permit Office
The places to keep record of permits are respective Permit Offices.

Permit Register
A register maintained by the permit Issuing Authority for all work permits issued on
daily basis.

Rigging Work
Any work that involves lifting of load with a lifting device / machine.

Restricted Area
x Electrocution due to the close proximity of electrical conductors or other electrical
apparatus (e.g. transformers, switch-gears, substations, etc.);
x Toxic Fumes, Hydrogen Sulphide or a lack of Oxygen (e.g. sewers, confined spaces,
waste water treatment unit, wellhead cellars, chemical lab, etc.);
x Hazardous Areas - areas as defined on the Hazardous Area Classification Drawings
as being Class I, Div. 1 (Zone 0 & 1) or Class I, Div. 2 (Zone 2).

Residual Hazard
Residual hazards are the hazards those are still present after the preparation has
been done for safe execution of the job i.e. isolation of equipment from energy source.
Additional precautions and special PPEs are required to control the residual hazards
for any activity.

Rigging Plan
The rigging plan details of how the lifting operations shall be undertaken, the lifting
equipment and lifting accessories to be used, how the equipment and lifting
accessories shall be rigged up and the control measures in place to manage the risks.
It is required only for critical lifts.

Spade / Blanking List

This list must be cross referenced in Isolation Certificate. Spade, Spectacle blinds and
Blank flanges must be of a grade comparable to or exceeding the pipe work
specification into which they are to be inserted. The hazard of inserting a spade
should be carefully assessed before attempting the operation. Ideally full specification
spades must be used. In case where there is space constraint between the flanges
thinner spade can be used, after a risk assessment.

Safety Critical Device

Safety Critical device are those which are in place to prevent or mitigate the major
accident

Safety Critical Defeat Certificate

(SCDC) Safety Critical Defeat Certificate is required whenever a Safety Critical Device
is inhibited and is to be cross referenced in PTW.

Vehicle Entry Permit

Vehicles Entry Permit is required when a vehicle is to enter into restricted area, Gas
test shall be required and gas test box provided in the Permit must be filled if the
vehicle has to leave the designated track and has to enter in zone 2.

Vehicle Entry
Entry of a vehicle or an engine (prime mover) driven equipment into a Restricted Area
or a hazardous Area.

Zone Classification
An area in which a flammable atmosphere is, or may be expected to be present.
Special precautions for any work activity are necessary. Hazardous areas are
categorized into three zones: Zone 0, Zone1 and Zone 2.

Zone 0
Flammable gases and vapors are constantly present.

Zone 1
Flammable gases and vapors are intermittently present.
Zone 2
Flammable gases and vapors are not expected to be present unless conditions are
abnormal.

5. PROCEDURE:
5.1 Permit to Work (PTW)
Any work involving construction, inspection, maintenance, modification Pre-
commissioning, commissioning and demolitions in Project will be done under Permit
to Work system.

5.1.1 The only other exemption is an emergency when a job can be executed in
the presence of issuer and accepter. But such jobs should be 100%
supervised by issuing and Performing Authority.
5.1.2 Permit may be cancelled, recalled or suspended by Issuing Authority or with
advice of HSE Coordinator and/or Site Manager as activities dictate or
situation demands.
5.1.3 In accordance with Descon Rules and Norms, any person is authorized to
Stop Work in case he feels that a safety issue needs to be addressed. In
case the work is stopped, the permit shall be considered as suspended and
shall be revalidated by issuing authority.
5.1.4 Generally Hot Work is not allowed on live Equipment. In certain
circumstances it may be necessary to weld on live equipment with special
precautions and approval from commissioning manager and client.
5.1.5 All fields / columns of PTW shall be filled. All fields which are not required
shall be crossed out and nothing shall be left unfilled.
5.1.6 Cutting and over writing in PTW shall render it invalid and a new form shall
be filled.
5.1.7 Alteration done in any column of the PTW, after issuance of the permit /
certificates, specifically in job description will make the permit / certificate
invalid.
5.1.8 If the intent of PTW is changed a new Permit shall be issued.
5.1.9 In the event of an emergency, all permits/certificate(s) shall be suspended.
5.1.10 The permits must be revalidated or re-issued from the Issuing Authority
before work is resumed after an emergency is over.
5.1.11 In the event when permit or certificates were issued but both copies were lost
and equipment is still energy isolated, performing authority shall write/inform
to issuing authority and the whole process of PTW will be repeated to ensure
integrity.
5.1.12 In the event when one copy of the permit /certificate was lost, the Issuing
Authority will issue a photocopy of the soft or upper available in the record
and mark as duplicate for completion / close out of the job.
5.1.13 The record of all permits (hard copy) along with supporting documentation
shall be maintained for 06 months
5.1.14 Permit / Certificate Validity / Revalidation
All permits are valid for maximum two consecutive shifts. However, a revalidation is
mandatory on every shift change within two hours, after communication between in-
coming and out-going shift. After 24 hours (i.e. revalidation by two shifts) from the
time of issue, permit shall expire and new permit shall be raised. Cold Work Permits
shall be issued for 24 hrs.\, the permit may be issued/ extended for 07 days. Cold
Work Permits shall be revalidated on every shift change. All certificates are valid for

the duration of permits, against which these are being issued, with the exception of
Confined Space Certificate for which the validity is only for 24-hrs . Vehicle entry
permit is valid for 24-hours and can be extended for 07-days. Revalidation on each
shift change shall be mandatory. Hot work Permit shall be valid for 24 hrs only and
shall be revalidated on each shift change.
Permits (Cold, Hot& Vehicle Entry) shall be revalidated if any of the following is
observed during work:
1. Scope of work changes
2. A significant change occurs in the workgroup.
3. New hazard become apparent which may have significant effect.
4. In case there is a change in any of the PTW authorities, then all signatories
have to endorse the permit. It will be the responsibility of the authority that has
been replaced to get the signatures.
5. Permit was suspended due to an emergency or a lapse of two hours from the
time Area Authority has signed the permit.

5.1.15 Job Safety Analysis (JSA): For all non-routine critical jobs, JSA shall be
required along with the permit. JSA shall be prepared on a prescribed format
as per Descon Format “Job Safety Analysis”.

5.1.16 PTW Exceptions: Certain activities may not require a PTW and be carried out
on verbal instruction. They must meet all of the conditions below:
This may typically apply to the following activities:
x Regular activities in logistic operations, such as cargo handling, personnel
transfer, truck and car driving, QC inspections, etc.
x They are referenced in the list of activities not subjected to any Permit, duly
approved by the Site Manage

Permit To Work Flow Diagram

RAISE PTW & RELEVANT CERTIFICATE

(Performing Authority)

HIGHLIGHT SAFETY CHECK LIST HANDOVER TO AREA

AUTHORITY FOR PREPARATION
(Issuing Authority)

COMPLETE SAFETY CHECK LIST & ISOLATION

CERTIFICATE FOR JOB PREPARATION, INFORM AND
HANDOVER TO ISSUING AUTHORITY
(Area Authority)

COMPLETE ISOLATION / CERTIFICATE AND PTW &

ISSUANCE OF PERMIT TO PERFORMING AUTHORITY
(Issuing Authority)

HAND OVER COPY OF PTW & CERTIFICATES TO AREA

AUTHORITY FOR STARTING JOB (Performing Authority)

SIGN OFF BY AREA AUTHORITY AFTER COMPLETION OF

THE JOB
(Performing Authority)

RETURN PTW & CERTIFICATES AFTER COMPLETION OF

THE JOB AND UPDATE STATUS ON PTW
(Performing Authority)

W THE PTW IS NOW CLOSED

Work Permit Authority Matrix

Permit To Work Authority Matrix for Construction Activities

Confine
Heavy /
Cold Electrical/ d Space
Hot Work Critical
Authorities Work Vehicle Entry Excavation Mechanical Entry
Permit Radiograph Lift
Permit Permit Certificate Isolation Certific
y Certificate Certificate
Certificate ate

Issuing Constructi Construction Construction Construction Construction Construction Construction Construct

Authority on Manager Manager Manager Manager Manager Manager ion
Manager Manager

Performing Line Supr. Line Supr. Line Supr. Line Supr. Line Supr. Line Supr. Line Supr. Line
Authority Supr.

Area Authority Area I/C Area I/C Area I/C Area I/C Area I/C Area I/C Area I/C Area I/C

Permit To Work Authority Matrix for Pre-Commissioning & Commissioning Activities

Confine
Heavy /
d
Cold Electrical/ Critical
Hot Work Radiography Space
Authorities Work Vehicle Entry Excavation Mechanical Lift
Permit Certificate Entry
Permit Permit Certificate Isolation Certificat
Certific
Certificate e
ate

Issuing Commission Commission Commissioning Commissionin Commissionin Commissioning Commissio Commiss

Authority ing ing Manager g Manager g Manager Manager ning ioning
Manager Manager Manager Manager

Performing Line Supr. Line Supr. Line Supr. Line Supr. Line Supr. Line Supr. Line Supr. Line
Authority Supr.

Area Area I/C Area I/C Area I/C Area I/C Area I/C Area I/C Area I/C Area I/C
Authority

Permit To Work Authority Matrix for Maintenance & Workshop Activities

Confine
Electrical/ Heavy /
d Space
Cold Work Hot Work Vehicle Excavation Mechanical Radiograph Critical
Authorities Entry
Permit Permit Entry Permit Certificate Isolation y Certificate Lift
Certifica
Certificate Certificate
te

Issuing Maintenance Maintenance Maintenance / Maintenance / Maintenance / Maintenance / Maintenance Maintena

Authority / Operation / Operation Operation Operation Operation Operation / Operation nce /
Manager Manager Manager Manager Manager Manager Manager Operation
Manager

Performing Line Supr. Line Supr. Line Supr. Line Supr. Line Supr. Line Supr. Line Supr. Line Supr.
Authority

Area Area I/C Area I/C Area I/C Area I/C Area I/C Area I/C Area I/C Area I/C
Authority

5.2 Activity Flow and Form Completion

5.2.1 Cold Work Permit:
5.2.1.1 Work description should be clear and specific for the activities to be done.
5.2.1.2 Vague and general statements should not be used.
5.2.1.3 The Performing Authority shall raise the appropriate certificate(s), if required.
5.2.1.4 Area and performing authorities shall install appropriate Locks / Tags on
isolations, before issuance of isolation certificate.
5.2.1.5 Certificates are issued before issuance of PTW to ensure safe conditions for
execution of the specified work.
5.2.1.6 The Issuing Authority shall discuss the residual hazards with performing authority
and the Issuing Authority shall mention the Zone Classification and Residual
Hazard
5.2.1.7 The residual hazards must be controlled by using appropriate controls. All the
PPEs required for effective control of the residual hazards shall be arranged by
Performing Authority.
5.2.1.8 The Issuing Authority shall confirm the safety measures taken with respect to
equipment and to indicate PPEs required to overcoming the residual hazards
identified.
5.2.1.9 The Permit Issuing Authority will delegate Area Authority to inspect the job site
and carry out necessary isolation, de-pressurizing, lock-out of valves or
equipment.

5.2.1.10 Area Authority will ensure that any Electrical / Mechanical lock-out / isolation
procedures are followed; and that all applicable certificates are signed. Area
Authority will also ensure that all other activities associated with the safety check
list are completed.
5.2.1.11 The JSA/TRA shall be verified and signed by Issuing Authority / Area Authority.
5.2.1.12 The PPE mentioned in permit shall be verified and signed by Performing
Authority.
5.2.1.13 Requirements for gas testing if required, shall be specified by issuing &
performing authority and mentioned in relevant gas testing part of permit. Where
gas testing is required, maximum thirty minutes duration shall be enforced
between gas test and start of work. Requirement for intermittent or continuous
monitoring shall be decided by issuing authority”.
5.2.1.14 Permit is finally issued by signing by both issuing and performing authorities, in a
face to face meeting.
5.2.1.15 Permit is issued by Issuing authority.
5.2.1.16 The permit has two copies. The Issuing Authority will retain and display first copy
(soft or upper copy) in the Permit Office. The second (card or hard or hard copy)
of the permit will be with the Performing Authority.
5.2.1.17 Issuing Authority shall make an entry of each Permit number (i.e. printed number
on the Permit), in the permit register along with cross-reference of associated
certificate.
5.2.1.18 Before the actual commencement of job, if applicable, Performing Authority
should verify isolation.
5.2.1.19 Area Authority shall then authorize start of work and immediately inform Issuing
Authority (by radio / phone etc.) the time of start of job.
5.2.1.20 Issuing Authority shall record the time of start of job on soft or upper copy and
sign on behalf of Area Authority.
5.2.1.21 The job should be started within the two hours from the time of permit’s card or
hard copy signed by Area Authority. If the two hours’ time lapses than permit
needs to be revalidated from Issuing Authority.
5.2.1.22 Performing authority shall deliver the tool box talk and shall write the names of
work party (personnel carrying out work) in the permit on the card or hard copy.
Work party shall then sign in the respective section against their names. Extra
sheets shall be used in case the number of work party increases than the space
available in the permit. JSA shall also be discussed in detail a tool box talk with
the work party.
5.2.1.23 The permit should be revalidated by the in-coming shift Issuing Authority.
5.2.1.24 On completion of the job, the Performing Authority should take signature by Area
Authority (on card or hard or hard copy) and then return this permit (card or hard
copy) to the Issuing Authority.

5.2.1.25 The card or hard or hard copy should be matched up with the soft or upper copy;
Issuing Authority shall sign the soft or upper copy after the completion of the job in
a face to face meeting with Performing Authority.
5.2.1.26 Issuing Authority should sign soft or upper copy on behalf of Area Authority.
5.2.1.27 Permit will be signed off by all parties concerned and card or hard copy will be
filed in the Permit Office for the record / audit purpose. The record of all permits
along with supporting documentation shall be maintained for 06 months.

5.2.2 Hot Work Permit:

5.2.2.1 Performing Authority shall raise permit.
5.2.2.2 Work description should be clear and specific for the activities to be done.
5.2.2.3 Vague and general statements should not be used.
5.2.2.4 Dialogue between issuing and Performing Authority shall be done, before
identification of associated certificates requirements,
5.2.2.5 The Performing Authority shall raise certificate(s), if required before issuance of
permit to ensure safe conditions for execution
5.2.2.6 The Issuing Authority and Area Authority shall ensure that no other work which
could lead to the release/presence of flammable materials in the area where the
Hot Work has been permitted.
5.2.2.7 Issuing/area and performing authorities shall install appropriate Locks / Tags on
isolations, before issuance of isolation certificate. Positive isolation needs to be
done for hot job on process line or equipment.
5.2.2.8 The Issuing Authority shall discuss the residual hazards with performing authority
and check the Zone Classification and Residual Hazard respectively.
5.2.2.9 The residual hazards must be controlled by using appropriate controls. All the
PPEs required for effective control of the residual hazards shall be arranged by
Performing Authority.
5.2.2.10 The Issuing Authority shall check / tick the, to confirm the safety measures taken
with respect to equipment and to indicate PPEs required to overcoming the
residual hazards identified.
5.2.2.11 The Work Site Safety shall be verified and signed by Issuing Authority / Area
Authority and the PPE shall be verified and signed by Performing Authority.
5.2.2.12 The Area Authority will inspect the job site and carry out necessary isolation, de-
pressurizing, lock-out of valves or equipment.
5.2.2.13 The Performing Authority shall designate a Fire Watchman with required fire
fighting equipment for the Hot Work.
5.2.2.14 The Issuing Authority ensures that the Performing Authority along with Area
Authority verify any isolation or other action needed to ensure safety and make
sure the job is ready to start before signing of the permit.

5.2.2.15 Gas testing will be performed by authorized gas tester with valid calibrated gas
detector as specified in the Permit by a Gas Tester designated by the Permit
Issuing Authority. Where gas testing is required, maximum thirty minute duration
shall be enforced between gas test and start of work. Requirement for intermittent
or continuous monitoring shall be decided by issuing authority.
5.2.2.16 After all residual hazards have been listed and additional necessary precautions
are written by Issuing Authority. Permits preparations are complete by signing by
both issuing and performing authorities, in a face to face meeting.
5.2.2.17 The Hot Work Permit shall be issued as per Matrixes of PTW Authorities, before
being handed over for start of work.
5.2.2.18 Authorised sub contractor’s person (Vendor / sub-contractor supervisor) signs on
card or hard copy of the permit before commencement the work.
5.2.2.19 Before the actual commencement of job, if applicable, Performing Authority
should verify electrical isolation by pushing the equipment local button.
5.2.2.20 Area Authority shall then authorize start of work and immediately inform Issuing
Authority (by radio / phone etc.) the time of start of job.
5.2.2.21 Issuing Authority shall record the time of start of job on soft or upper copy and
sign on behalf of Area Authority.
5.2.2.22 Performing authority shall deliver the tool box talk and shall write the names of
work party (personnel carrying out work) in the permit on the card or hard copy.
Work party shall then sign in the respective section against their names. JSA shall
also be discussed in detail a tool box talk with the work party.
5.2.2.23 To ensure permit conditions have not changed, periodic gas checks will be made
during the job execution. In the event gas detected the work will be stopped and
the permit will be considered invalid till the area is declared as gas free. Permit
shall be revalidated before the start of work.
5.2.2.24 Immediately after the work is completed, the work area and adjacent areas will be
cleaned and inspected to ensure there has been no spread of sparks/heat or left
over.
5.2.2.25 On completion of the job, the Performing Authority should take signature by Area
Authority (on card or hard copy) and then return this permit (card or hard copy) to
the Issuing Authority.
5.2.2.26 The card or hard copy should be matched up with the permit copy (i.e. upper
copy) Issuing Authority shall sign the upper copy after the completion of the job in
a face to face meeting with Performing Authority.
5.2.2.27 Issuing Authority should sign of soft or upper copy on behalf of Area Authority.

Permit will be signed off in the appropriate places by all parties concerned and soft or
upper copy will be filed in the Permit Office for the record / audit purpose. The record of
all permits (card or hard copy) along with supporting documentation shall be maintained
for 06 months.

5.2.3 Vehicle Entry Permit:

5.2.3.1 The performing Authority shall raise permit.
5.2.3.2 All Descon/ sub-contractor vehicles should have fitness certificate provided by
maintenance which will be valid for one month.
5.2.3.3 All certified Descon Vehicles can enter in Descon area roads only (except
restricted area) without permit.
5.2.3.4 Issuing Authority shall issue the permit for the specific area(s) and time period.
5.2.3.5 The Issuing Authority will retain and display soft or upper copy in the Permit Office.
The card or hard copy of the permit will be with the Driver of the vehicle.
5.2.3.6 In case the vehicle has to additionally enter in another area, a new permit shall be
issued.
5.2.3.7 Area Authority should initiate a dialogue with the driver so as to ensure that he
understands all safety requirements.
5.2.3.8 Area Authority shall monitor the vehicle movement and the loading / unloading
operation (if any).
5.2.3.9 Area Authority should (if required) carry out / supervise gas testing of the area prior
to vehicle entry as well as periodic testing during the course of work and enter the
gas testing results.
5.2.3.10 All Descon/ sub contractors’ vehicles should have vehicle entry permit and will be
valid for 24hours and can be extended for seven days. Revalidation on each shift
change shall be required.
5.2.3.11 After the laps of 24 hours, permit shall be revalidated by Issuing Authority and
signed by the vehicle driver Authority and Area Authority.

5.3 CERTIFICATES:
5.3.1 Process/Mechanical/ Isolation Certificate
The Process/Mechanical Isolation Certificate is used to control:

x Electrical/Mechanical isolations on plant and equipment. These including valve

and spade /spec blind, isolations.
x Extended Period Isolations on plant and equipment.

Note: Process/Mechanical Isolation certificate is attached to a PTW, however where

a long-term isolation is required but no work controlled by a permit is necessary then
the Process/Mechanical Certificate may be used as a stand-alone document.

Application
The Requester (it can be for e.g. the Performing Authority or Issuing Authority) will
complete the initial overview of why the isolation is required.

x Location of the equipment to be worked on, along with the installation or site
name should be written.
x The equipment to be isolated along with associated tag number will then be
required.
x The associated PTW number(s) must be referenced on the Isolation Certificate.
This allows match up and clear visibility of isolation with associated work scope.
x If the isolation is being carried across to a follow-on PTW (e.g. the permit validity
period has expired but work is not complete, restarting work within an EPI
boundary) then this new PTW number will be entered.
x A brief description of the reason why isolation is required for the work to be
carried out will then be entered or ‘mechanical isolation to allow spades to be
inserted for confined space entry into vessel’. This description allows the
Isolating Authority to have an overview of why the isolation is required.
x The associated documents (P&IDs, drawing, etc.)
x The Requester will then enter his name, Sub contractor/department and sign and
date to apply for isolation.
x The Isolation Certificate will then be handed to an authorized Isolating Authority
for that piece of equipment.

Details of isolation
The Isolating Authority will then plan the isolation using P&IDs and if necessary line-walk
the process to ensure the P&ID’s are accurate. The Isolating Authority is to list and
mark-up on P&ID all points of isolation, indicating whether a valve is to be opened or
closed, and the location of all points of spade/blank isolation if necessary.
The Isolation Certificate will be populated giving a full description of the planned
isolation. The tag number of each isolation point or line number from the P&ID will be
recorded.
A Process/Mechanical Isolation Continuation Certificate is provided in appendix if there
is not enough room on the Certificate.
The Issuing Authority shall double check the marked up P&ID along with the isolation
details on the Isolation Certificate for robustness for the planned work.

Isolation
Once the isolation has been planned and the associated PTW has been approved,
authorization to isolate will be given by the Issuing Authority by signing of the Certificate.
Each isolation requires an isolation tag to be attached. These are individually numbered
and the Isolating Authority shall develop isolation tags and enter the tag number. When
the isolations are complete, the Isolating Authority is to sign confirming that the
equipment has been isolated and the isolations are holding. The Isolating Authority is
responsible for ensuring that spade tags are written and secured to spade/blanked
disjointed isolation points. Prior to releasing the isolation for work commencement, the
Area Authority must verify the planned isolation has been correctly applied, then sign
and date to confirm that the equipment can be worked upon.
A copy of the certificate is then attached to a copy of the permit for display at the Permit
Issue Point .Another copy is attached to the worksite copy of the permit for display at the
worksite.

Important Notes:
x If bleeding off, draining down, venting or any other release of hydrocarbon to
atmosphere is required this must be completed and verified before an Isolation
Certificate is raised. Any conflicting activity must be suspended prior to bleeding off,
draining down, venting or any other release of hydrocarbon to atmosphere.
x If breaking of containment is required to install blinds/spades as part of the isolation,
a dedicated permit is to be raised to cover this specific activity.

De-isolation
Except where a test is required to confirm satisfactory completion of the work covered by
the Permit (De-isolation for Test Certificate to be used), de-isolation is not to take place
until it has been certified that the work is sufficiently completed to allow de-isolation. This
is done by completing the Isolation Certificate (typically by the Performing or Area
Authority), and after the Permit has been returned by the Performing Authority to the
Area Authority by signing the Permit.
The Area Authority indicates the PTW if the isolations can now be removed. The Issuing
Authority checks that no other permits are opened within the same isolation boundary,
and confirms if isolation(s) can be removed by signing the Isolation Certificate to
authorise the de-isolation.
The Isolating Authority may then remove the valve isolation tags and de-isolate the
valves.
At de-isolation, the Isolating Authority is to list all points of de-isolation indicating removal
of spades/blanks and reinstatement of valves is necessary. On completion of de-
isolation, the Isolating Authority then signs.
Finally the Area Authority signs to confirm isolation has been removed and the
equipment can be brought back into service, provided the PTW has been closed-out by
the Issuing Authority.

Important Notes:
If the de-isolation requires removal of blinds/spades, it will be covered by a dedicated
Permit to Work, specific to this activity. The Permit used to install the blinds/spades can
be re-accepted and re-authorised providing it remains within the validity period. If not, a
new Permit must be applied for before breaking of containment commences.
x When all blind/spade de-isolations are completed and the Isolating Authority is
satisfied that de-isolation is complete and the disturbed flanges have been pressure
tested, the specific permit to remove the blinds/spades can be closed-out.

Extended Period Isolation (EPI)

If the equipment is to be left isolated, the permit is to be cancelled (the work is complete
but the equipment shall remain isolated) or (the Performing Authority is not able to
complete the work and work won’t restart immediately with a continuation permit). The
Issuing Authority uses the (EPI ON) of the worksite and Permit Issue Point isolation
certificate(s) to confirm the EPI, giving the reason and entering the number of the
closed-out permit together with their name, signature, time and the date at which the EPI
is implemented.

The worksite and Permit Issue Point isolation certificate(s) are to be placed in the EPI
slot in the permit rack. The Area Authority is to check to ensure all isolations and tags
remain in place.
When a work will restart within the EPI boundary, a new permit shall be raised. The
copies of the original isolation certificate will be recovered from the EPI slot of the permit
rack and the certificate will be reauthorize by the Issuing Authority, taking off the EPI by
filling in (EPI OFF) of the certificate.
The number of the new permit will be entered, as well as the Issuing Authority name,
signature, time and the date when the EPI has been removed. The Issuing Authority
then attaches the certificate to the new permit, and work may proceed once the permit
has been issued, accepted and authorised.

5.3.2 Electrical Isolation Certificate:

x Where electrical isolation is required as a preparation for work as described in
the permit
x For long term isolation of electrical circuits.
Note: Normally an Electrical Isolation certificate is attached to a PTW, however
where a long-term isolation is required but no work controlled by a permit is
necessary then the Certificate may be used as a stand-alone document.

Application
The Requester (it can be for e.g. the Performing Authority or Issuing Authority) will
complete the initial overview of why the isolation is required. This will require mentioning
in the certificate
x Location of the equipment to be worked on, along with the installation or site name
should be filled in.
x The equipment to be isolated along with associated tag number will then be
required.
x The associated PTW number(s) must be referenced on the Isolation Certificate. This
allows match up and clear visibility of isolation with associated work scope.
x If the isolation is being carried across to a follow-on PTW (e.g. the permit validity
period has expired but work is not complete, restarting work within an EPI boundary)
then this new PTW number will be entered.
x A brief description of the reason why isolation is required for the work to be carried
out will then be entered. This description allows the Isolating Authority to have an
overview of why the isolation is required.
x The associated documents (Single Line Diagram, Loop Drawing, etc.)
x The Requester will then enter his name, contractor/department and sign and date to
apply for isolation.
x The Isolation Certificate will then be handed to an authorized Isolating Authority for
that piece of equipment.

Details of isolation
The Isolation Certificate will be populated giving a full description of the planned
isolation.
The Isolating Authority will then plan the isolation. The Isolating Authority is to list:
x All points of isolation with a unique identification number.
x The electrical equipment ID number.
x The isolation point together with the location at which the caution notice/padlock
will be placed.
x The Isolation method (e.g. removal of main fuses or racking out breaker)
x A tick in the safety padlock box as required
x A tick in the Lockout Box as required
x A tick in the fuse removal box as required.
x Additionally, a section is available to record ‘Additional Precautions’. This is
present to record such facts as a Limitation of Access being required due to
close proximity of live conductors, etc., which cannot be isolated easily, and not
necessarily being required to be isolated for the specific work task.

The Issuing Authority shall double check the isolation details on the Isolation
certificate for robustness for the planned work. For electrical isolations the
Isolation Authority must be an Authorized Electrical Person

Isolation
Once the isolation has been planned and the associated PTW has been issued,
authorization to isolate will be given by the Issuing Authority by signing the
Certificate.
The person undertaking the isolation should be the same person that identified the
requirements.
The Isolating Authority shall enter:
x The unique identification number of the safety padlock used to secure the
isolation(s)
x The lockout box number in which the key(s) for the safety padlock(s) are held
x The location of any fuses removed during isolation (normally either inside the
cubicle, or if small, within the lockout box)
Once the above information has been provided and the isolation has been carried
out, the requisite shall be completed by the electrical person who carried out the
isolation.
A copy of the certificate is then attached to a copy of the permit for display at the
Permit Issue Point.
Another copy is attached to the worksite copy of the permit for display at the
worksite.
It is recommended that a 3rd copy is retained by the electrical personnel.
Prior to releasing the isolation for work commencement, the Area Authority must
verify the planned isolation has been correctly applied, then sign and date Box 4c to
confirm that the equipment can be worked upon.

De-isolation
Except where a test is required to confirm satisfactory completion of the work
covered by the Permit (De-isolation for Test Certificate to be used), de-isolation is
not to take place until it has been certified that the work is sufficiently completed to
allow de-isolation.
This is done by entering in the Certificate (typically by the Performing or Area
Authority), and after the Permit has been returned by the Performing Authority to the
Area Authority by signing of the Permit.
The Area Authority indicates in the PTW if the isolations can now be removed.
The Issuing Authority checks that no other permits are opened within the same
isolation boundary, and confirms if isolation(s) can be removed by signing the
Isolation Certificate to authorize the de-isolation.
The Isolating Authority may then perform the de-isolation and complete the
declaration, having matched all copies of the certificate.
Finally the Area Authority signs to confirm isolation has been removed and the
equipment can be brought back into service provided the PTW has been closed-out
by the Issuing Authority.

Extended Period Isolation

If the equipment is to be left isolated, the permit is to be cancelled (the work is
complete but the equipment shall remain isolated) or (the Performing Authority is not
able to complete the work and work won’t restart immediately with a continuation
permit).
The Issuing Authority (EPI ON) of the worksite and Permit Issue Point isolation
certificate(s) to confirm the EPI, giving the reason and entering the number of the
closed-out permit together with their name, signature, time and the date at which the
EPI is implemented

5.3.3 Confined Space Entry Certificate:

Confine Space Entry Standard must be followed as the minimum standard when
Confine Space is necessary.
Personnel are not allowed to enter confined space until the Certificate is issued. The
Confined Space Entry Certificate shall not be issued until all applicable requirements
identified have been met.
No confine space entry is proceed unless competent confine space entry attendant
stationed, how shall sign on Duties of Confine Space Entry Form
Only trained and authorized personnel shall allow / authorize any entry into a
confined space. Name and timings shall be recorded on Confined space entry log
sheet format as prescribed in this Standard “Permit to Work”
A copy of the Confined Space Entry Certificate, Job Safety Analysis, rescue Plan
and Confined Space Standard Isolation Sheet for Entry, along with the permit,
Confine Space Attendant Form, should be pasted in an easily visible location at the
confined space entry site until the Certificate is cancelled.

Confined Space Entry Certificate should be valid only for the period required to
complete the assigned task described on the Certificate.
The entry should be terminated and Confined Space Entry Certificate stands
cancelled when:
5.3.3.1 The job is complete and entrants have exited the space, and the space is
ready to be returned to normal service.
5.3.3.2 A condition occurs in the permitted confined space that has not been
anticipated or allowed by the Confined Space Entry Certificate during the
authorized entry period.
5.3.3.3 A work interruption of more than two hours.
5.3.3.4 In the event of a local or facility emergency.
A debriefing session between the Performing Authority and the entry workers shall
occur whenever a Confined Space Entry Certificate is cancelled.
A complete review of Confined Space Entry Certificate should be conducted if:
x The Performing Authority changes while work is ongoing;
x A shift change occurs before work is completed.
x Permit time limitations are met or exceeded.
Any problems encountered and/or corrective measures taken during entry
operations should be noted on the Confined Space Entry Certificate.
This establishes necessary information for preparations, entry and restoration of a
vessel and confined space to be entered by personnel. These procedures are
designed to maintain a safe environment for personnel working in a vessel or
confined space.
A “Confined Space Entry Permit” shall be issued for personnel to enter into the
confined space after the following precautions are satisfied:
x The atmosphere inside the confined space has a normal oxygen content of
20.8% and it is free from toxic vapours and gases.
x The personnel shall not enter the confined space if:
o The Oxygen content is less than 19.5%.
o The Oxygen content is greater than 23.5%.
o The presence of flammable vapours or gases at concentration above the 0%
LFL (Lower flammable limit) during commissioning and 5 % LFL during
construction.
o The presence of toxic vapours and gases above the occupational exposure
standard for a 10 minute exposure.

x Personnel may enter the confined space wearing suitable and approved
respiratory equipment if the presence of toxic vapours and gases below the
Lower Threshold Limit Value (LTLV).

Entry into Confined Spaces with Breathing Apparatus BA

If it is not possible to class the space as "Safe for Entry without BA," the "Entry with
BA" may be permitted with the following additional precautions:
x An approved positive pressure BA is worn.
x Authorization for Entry with BA has been given.
x Where practicable, retrieval gear is worn.
x The Entry Attendant must be stationed outside the space entrance at all times.
x Rescue and resuscitation equipment and qualified personnel shall be readily
available.
5.3.4 Excavation Certificate:

All excavations are to be controlled by an excavation certificate.

It should be noted that the excavation certificate is for recording the details of the
excavation, any hazards and the necessary precautions and mitigations. It does not
authorise any work to be executed, this will be controlled under a permit to work.
The Excavation standard must be followed as the minimum standard when
excavation is necessary.
An excavation is any man-made cut, cavity, trench, or depression in an earthen
surface that is formed by earth removal. The Excavations Certificate, cross-
referenced to all relevant PTW, shall be the principal means of control of
excavations. Excavation work can only commence after the Permit to Work to which
the Excavation Certificate is appended is opened.
The Excavation Certificate shall be raised by the Civil Competent Person in charge
of the preparation of the excavation work. The completed certificateis to be received,
in the first instance by the Issuing Authority, prior to the start of excavation work.

The Excavation Certificate shall contain:

x A risk assessment for the hazards being exposed from the excavation.
x Precautions and mitigations to be put in place to manage the risk.
x A drawing of sufficient scale to clearly define the excavation boundaries.
x The latest underground services drawings/details.
x Required response if a service is damaged if applicable.
x Reinstatement confirmation.
x Authorization and acceptance sections for signatures.
x Prior to permit issue, the following must also be in place:
x All Isolation Certificates for the excavation have been checked and validated, if
applicable.
x All attached documents should be reviewed (e.g. P&IDs, site underground lay
out drawings).

x The risk assessment has been carried out (in particular, all power, pilot or tracer
cables that are within the excavation zone, overhead and below ground, must be
located and identified).
Application
The location of the proposed excavation work shall be provided in this section, along
with a reference to the associated Permit to Work. The Civil Competent Person shall
complete this section with their details.

Details of Excavation
The Civil Competent Person shall complete this section with relevant information, i.e.
purpose of excavation, excavation methods to be employed and other general
information about the excavation

Attachments
Drawings, sketches or other documents should be specified and described here by
the Civil Competent Person (and preferably appended to the certificate).

Known Underground Services

The location of the excavation site (i.e. Greenfield or brownfield) will usually
determine the quality and availability of documentation available detailing the
presence of underground services. In this section, the Civil Competent Person
should provide pertinent information relating to the ‘known’ services. This information
is to assist the excavation team in locating and marking the routes of the
underground services prior to starting any excavation works.

Precautions and Mitigations

The Civil Competent Person, in conjunction with the Performing Authority. In this
area the precautions and mitigations needed to ensure a safe work environment
shall be specified.
These precautions and mitigations should clearly define the pilot trenches to be dug,
the means used to dig the trenches (manual or mechanical), the type of excavation
protection required (shoring, battering or benching) as well as other worksite
safeguards.

Verification
The Performing and Area Authorities shall verify on site that the precautions and
mitigations specified in certificate are being complied with.
This activity also allows a final check on the adequacy or suitability of the proposed
precautions and mitigations.

Authorization
The Authorisation part of the certificate is to be signed by the Area Authority. This is
to confirm that they are satisfied with the content of the Excavation Certificate,
associated Permit to Work and other supporting documentation. The signature
indicates that the precautions and mitigations proposed are suitable and sufficient.

5.3.5 Radiography Certificate:

Radiography Certificate shall be prepared under the or cold work permit when a
radio-active source is employed or a potential for exposure to radioactivity exists.

The essential features of radiography certificates are as follows:

5.3.5.1 Source strength (curie) and isotope type should be clearly defined.
5.3.5.2 Radiographic workers to keep valid and approved dosimeter/film badges.
5.3.5.3 Calibrated detection meter to be available.
5.3.5.4 Fencing/cordoning and warning sign to be posted at a suitable distance
from the proposed exposure point so that worker will not be exposed to
radiation above the maximum level of 2.5 micro SV/hr and for
radiographers 7.5 micro SV/hr.
5.3.5.5 Consideration should be given to performing radiography at night when the
personnel on site are at a minimum use. Flash lights / barricade tape and
site–wide announcement on public address system should be made prior to
radiography commencing.
5.3.5.6 All sources should be locked on and properly stored in designated storage
area.
5.3.5.7 Radiography Checklist provided in certificate shall be filled by Performing
Authority and attached with the certificate.
The Performing Authority initiates the certificate by completing the relevant sections.
In the certificate the Performing Authority will designate a Radiographer to carry out
the work detailed on the certificate by entering his name, radioactive license number
and exposure badge number.
The Area Authority will carry out all the precautionary measures specified in the
certificate and initial each relevant box when each precautionary measure is
completed.
The Performing Authority will then brief the Radiographer on the work plan, the
precautionary measures to be taken and the Emergency Alarms/Response Plan.
The Radiographer will brief the work crew on the contents of certificate, any
limitations and restrictions, the safe work procedures and the Emergency
Alarms/Response Plans. The Radiographer and the Performing Authority Supervisor
will check and ensure that the work detailed on the certificate has been completed.
5.3.6 Heavy Lift Certificate:
A Heavy Lift certificate shall be obtained for jobs involving moving/lifting of heavy
loads (critical Lifting), Lifting over live process equipment, lifting involving two or
more lifting/pulling appliance.
A Rigging Plan will be required if the lifted load has to be shifted / transferred
through critical areas. This will mitigate the possibility of causing damage to pipe

work, cable trays and equipment, underground / overhead cables, buildings etc. due
to the fall / hitting of load due to operational reasons or accidents. Heavy Lift
Certificate details precautions that need to be taken to minimize the risk to lift or
other equipment and to ensure that access and emergency escape routes are kept
clear at all times.
5.3.7 Safety Critical Defeat Certificate:
Safety System Defeat Certificates should be used when Safety Equipment, Element
or system are either being defeated by inhibit, bypass, override or by linking out the
system during the commissioning activity or in brown field. Since safety systems are
critical to maintain the integrity of the site it is vitally important that when systems are
negated either for work, or due to systems being defective, that appropriate controls
are put in place to ensure mitigations are applied to ensure risks remain as low as
reasonably practicable during the normal running of the site.
A full range of systems require a Safety System Defeat Certificate that are tagged as
Safety Critical Elements or Systems.
When a system is required to be defeated, a ’Safety Systems Defeat Certificate’ will
be developed to gain approval and authorization prior to the system being negated.
Safety System Defeat Certificate has to be used in conjunction with the Defeat
Register of the Control Room.
Safety System Defeat certificate is attached to a PTW, however where no work
controlled by a permit is necessary (e.g. defective gas detector to be inhibited) then
the Safety System Defeat Certificate may be used as a stand-alone document. In
this case, the issuance from the issuing Authority shall be obtained on the
Certificate.

6. TRAINING AND AWARENESS:

Issuing Authority, Performing Authority, Area Authority, Gas Tester, Confined Space
Attendant, Fire Watcher, Radiography Protection Officer, and Isolation Authority
shall attend the formal training of permit to work.
Specialized trainings shall be delivered to for Gas Tester, Confined Space Attendant,
Isolation Person, Radiography Protection Officer and Fire Watch Man. After passing
these trainings with 80% marks, they are authorized to perform their duties.
Permit to work Awareness session shall be conduct to aware the employees about
implementation of Permit to work system to control and manage the workplace
Hazards and Hazardous activities.
7. REFERENCE &RELATED DOCUMENTS:
x Authorization for Competent Gas Tester HSE/FRM-07
x Authorization for Confined Space Attendant HSE /FRM-08
x Authorization for Fire Watch Man HSE/FRM-09
x Authorization for Isolation HSE/FRM-10
x Isolation Register HSE/FRM-11
x Master Isolation Control Sheet HSE/FRM-12
x Cold Work Permit HSE/FRM-13
x Hot Work Permit HSE/FRM-14

x Vehicle/Equipment Entry Permit HSE/FRM-15

x Confined Space Entry Certificate HSE/FRM-16
x Excavation Certificate HSE/FRM-17
x Radiography Certificate HSE/FRM-18
x Gas Test Certificate HSE/FRM-19
x Heavy Lift Certificate HSE/FRM-20
x Electrical/Mechanical Isolation Certificate HSE/FRM-21
x Electrical/Mechanical Isolation Continuation
Certificate HSE/FRM-21A
x Safety System Defeat Certificate HSE/FRM-22
x Safety System Defeat Register HSE/FRM-23
x Permit to Work Log Book HSE/FRM-24
x Descon HSE Management System Framework
x OHSAS 18001:2007 HSMS Standard
x Occupational Safety and Health Administration (OSHA) USA
x HSE Executive – UK

This document is the Intellectual Property of Descon Engineering Limited. Any unauthorized use, including the modification
and reproduction of the content is strictly prohibited. © Copyrights Ordinance 2002, All Rights Reserved.
Doc No: HSE/FRM-07
Rev: 00
Authorization for Competent Gas Tester Date of Rev: June 22, 2016
Page: 1 of 1

Project Name:_____ Project Number:

Date of Issuance: Valid Up To: _

Serial Name & Designation of the

Reporting To Area which the authority relates to
Number Person Authorized

Trainer Initials Supervisor Initials Project / Site Manager Initials

_ _______________

Doc No: HSE/FRM-08
Rev: 00
Authorization for Confined Space Attendant Date of Rev: 22-June-2016
Page: 1 of 1

Project Name:_____ Project Number:

Date of Issuance: Valid Up To: _

Name & Designation of the

Serial Number Reporting To Area which the authority relates to
Person Authorized

Trainer Initials Supervisor Initials Project / Site Manager Initials

_ _______________

Doc No: HSE/FRM‐09
Rev: 00
Authorization for Fire Watch Man Date of Rev: 22‐June‐2016
Page: 1 of 1

Project Name:_____ Project Number:

Date of Issuance: Valid Up To: _

Serial Name & Designation of the

Reporting To Area which the authority relates to
Number Person Authorized

Trainer Initials Supervisor Initials Project / Site Manager Initials

_ _______________

Doc No: HSE/FRM-10
Rev: 00
Authorization for Isolation Date of Rev: 22-June-2016
Page: 1 of 1

Project Name:_____ Project Number:

Date of Issuance: Valid Up To: _

Serial Name & Designation of the

Reporting To Area which the authority relates to
Number Person Authorized

Trainer Initials Supervisor Initials Project / Site Manager Initials

_ _______________

Doc No: HSE/FRM‐11
Rev: 00
ISOLATION REGISTER Date of Rev: 22‐June‐2016
Page: 1 of 1

Location:

Transferred to
Isolation
Associate Isolating Date Issueing Date De‐ Issueing extended
Certificate Worksite Isolation Description EPI Cancelled
d Permit # Authority Isolated Authority Isolated Authority period
#
isolation
Doc No: HSE/FRM-12
Rev: 00
Master Isolation - Control Sheet Date of Rev: 22-June-2016
Page: 1 of 1

Project Name : __ Project Number:_

Section - 1 Details of System under Master Isolation

Master Isolation
Location / Installation:
Certificate No.

System:

Associated Drawing
No.

Vessel / Equipment:

Sectiobn -2 Work Associated with Master Isolation

Permit and Ceritificate No. s

Job Isolation De-Isolate for Test

Description Hot Work Permit Cold Work Permit Date Opened Date Closed Remarks
Number Certificate Certificate
Doc No: HSE/FRM-13
Rev: 00
Date of Rev: 22-June-2016
COLD WORK PERMIT Page: 1 of 1

DESCRIPTION OF WORK PERMIT VALID FOR DATE OF ISSUE ONLY

LOCATION: SECTION EQUIPMENT

WORK DESCRIPTION ZONE CLASSIFICATION

0 1 2

DATE PERMIT DURATION FROM: HRS TO: HRS

WORKSITE RESPONSIBILITY/HAZARDS/SAFETY CHECK LIST

ANY CERTIFICATES RADIOGRAPHY CONFINED EXCAVATION ISOLATION VEHICLE ENTRY

REQUIRED FOR THIS SPACE ENTRY (Mechanical/Proc
WORK YES/NO ess/ Electrical)

HAZARDS IDENTIFICATION

Excavation Works Confined Space Lifting/ Rigging

Hazardous Products or Materials Electrical Work Restricted Access

Working at height Hot material / Surface Noise/ vibration

Individuals Exposure (Voltage/Moving Manual Handling Of Material Adverse Weather
parts/ Equipment starting
CHECK LIST ACTION TAKEN CHECK LIST ACTION TAKEN

EQUIPMENT YES NO N/A P.P.E. YES NO N/A

SELF CONTAINED BREATHING

DEPRESSURED
APPARATUS

VENTED SUPPLIED AIR BREATHING APPARATUS

WATER FLUSHED EYE PROTECTION

DRAINED HAND & FACE ROTECTION

PURGED HEARING PROTECTION

VALVES ISOLATED RESPIRITORY PROTECTION

SPOOLS DISCONNECTED CHEMICAL PROTECTION

MECHANICAL VENTILATION HEAD PROTECTION

NATURAL VENTILATION FALL/RESTRAIN PROTECTION

ISOLATION BY BLINDS LIFELINE

ELECTRICAL ISOLATION LADDER

SAFETY SYSTEM BYPASS CERTIFICATE FLAMEPROOF LIGHTING

OTHERS: OTHERS:

ADDITIONAL PRECAUTIONS & CONDITIONS:

ISSUE
WE THE UNDERSIGNED HAVE PERSONALLY INSPECTED THE JOB SITE AND AUTHORIZE THE WORK TO PROCEED IN ACCORDANCE WITH THESE CONDITIONS. ANY
CHANGE IN THESE CONDITIONS WILL INVALIDATE THIS PERMIT.
ISSUEING AUTHORITY PERFORMING AUTHORITY AREA AUTHORITY
SIGN: SIGN: SIGN:

DATE: DATE: DATE:

TIME TIME: TIME:
COMPLETION/EXTENSION
JOB COMPLETED YES / NO WORK PERMIT EXTENDED YES / NO EXTENDED UPTO: Hrs

SIGNATURE(ISSUER):

WE THE UNDERSIGNED HAVE PERSONALLY INSPECTED THE WORK SITE AND DECLARE THAT THE AREA HAS BEEN LEFT SAFE, CLEAN AND TIDY. UPON COMPLETION
ALL GUARDS AND COVERS ARE IN PLACE AND ALL TOOLS AND MATERIALS HAVE BEEN REMOVED.
PERFORMING AUTHORITY& CONTRACTOR’S REP JOB COMPLETED HANDED BACK TIME DATE

SIGN: YES / NO YES / NO

PERMIT ISSUER EQUIPMENT ACCEPTED BACK TIME DATE

SIGN: YES / NO
ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc No: HSE/FRM-14
Rev: 00
Date of Rev: 22-June-2016
HOT WORK PERMIT Page: 1 of 1

LOCATION: SECTION EQUIPMENT

WORK DESCRIPTION: ZONE CLASSIFICATION

0 1 2

DATE PERMIT DURATION FROM: HRS TO: HRS

WORKSITE RESPONSIBILITY DELEGATED TO POSITION SIGNATURE

NAME: SIGN DATE/TIME

ASSOCIATED DOCUMENTS P&ID, SLD,PFD Risk Assessment Associated Permit Method Statement

ANY CERTIFICATES REQUIRED FOR RADIOGRAPHY CONFINED SPACE ENTRY EXCAVATION ISOLATION VEHICLE ENTRY
THIS WORK

CHECK LIST ACTION TAKEN CHECK LIST ACTION TAKEN CHECK LIST REQUIRED

EQUIPMENT YES NO N/A WORK AREA YES NO N/A P. P. E. YES NO N/A

SELF CONTAINED
DEPRESSURED FLAMMABLE GAS TEST
BREATHING APPARATUS
SUPPLIED AIR
VENTED TOXIC GAS TEST
BREATHING APPARATUS
WATER FLUSHED OXYGEN CONTENT EYE PROTECTION

DRAINED CONTINUOUS GAS TEST HAND & FACE ROTECTION

PURGED WARNING SIGNS/BARRICADES HEARING PROTECTION

VALVES ISOLATED EXITS CLEAR RESPIRITORY PROTECTION

SPOOLS DISCONNECTED FIRE EXTINGUISHER CHEMICAL PROTECTION

MECHANICAL VENTILATION FIRE WATCH HEAD PROTECTION

NATURAL VENTILATION OPEN DRAINS FLUSHED FALL PROTECTION

ELECTRICAL ISOLATION OPEN DRAINS COVERED LIFELINE

SAFETY SYSTEM BYPASS FIRE BLANKET/CANOPY LADDER
CERTIFICATE
OTHER WORK IN THE VICINITY FLAMEPROOF LIGHTING
THAT CAN EFFECT THIS PERMIT
OTHER (SPECIFY)
OTHER PPE (SPECIFY)
SPECIFY OTHER PRECAUTIONS
Immediately prior to work commencement  Daily before work commencement  Continuous  During work progress every …………………… hours
ATMOSPHERIC TESTING REQUIRED TO MAINTAIN A SAFE ATMOSPHERE
DATE TIME LEL% H2S PPM O2 % OTHERS CHECKED BY

ISSUE PERMIT
WE THE UNDERSIGNED HAVE PERSONALLY INSPECTED THE JOB SITE AND AUTHORIZE THE WORK TO PROCEED IN ACCORDANCE WITH THESE CONDITIONS. ANY CHANGE IN THESE
CONDITIONS WILL INVALIDATE THIS PERMIT.
ISSUING AUTHORITY PERFORMING AUTHORITY AREA AUTHORITY
DATE/TIME

SIGN DATE/TIME PERMIT RECEIVER CONTRACTOR REP. SIGN DATE/TIME

EXTENSION / COMPLETION
JOB COMPLETED YES / NO WORK PERMIT EXTENDED YES / NO EXTENDED UPTO: Hrs.

SIGNATURE(ISSUER):

WE THE UNDERSIGNED HAVE PERSONALLY INSPECTED THE WORK SITE AND DECLARE THAT THE AREA HAS BEEN LEFT SAFE, CLEAN AND TIDY. UPON COMPLETION ALL GUARDS AND
COVERS ARE IN PLACE AND ALL TOOLS AND MATERIALS HAVE BEEN REMOVED.
PERFORMING AUTHORITY & CONTRACTOR’S REP. JOB COMPLETED HANDED BACK TIME DATE

SIGN: YES / NO YES / NO

ISSUING AUTHORITY EQUIPMENT ACCEPTED BACK TIME DATE

SIGN: YES / NO

ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc No: HSE/FRM‐15
VEHICLE/EQUIPMENT ENTRY PERMIT Rev: 00
Date of Rev: 22‐June‐2016
Page: 1 of 1
SECTION 1 – DESCRIPTION OF VEHICLE/EQUIPMENT VALID FOR DATE OF ISSUE ONLY
LOCATION: SECTION EQUIPMENT

PERSON IN CHARGE DRIVER: ZONE CLASSIFICATION 0 1 2

TYPE OF VEHICLE AND/OR EQUIPMENT

PURPOSE OF ENTRY

VEHICLE(S) NUMBERS DRIVING LICENSE NO.

DATE DURATION Hrs To Hrs

SECTION 2 – SAFETY CHECK LIST

ACTION TAKEN ACTION TAKEN

CHECK LIST YES NO CHECK LIST YES NO

OPERATOR/ DRIVER ON STAND-BY
FIRE EXTINGUISHER
DUTY
VEHICLE ROUTE IS CLEAR CHOCKS REQUIRED
VEHICLE FITTED WITH FLAME
CONTINUOUS GAS MONITORING
ARRESTOR
OTHER WORK IN THE VICINITY THAT
OVERHEAD OBSTRUCTIONS HAVE BEEN CHECKED
CAN AFFECT THIS PERMIT
VALID DRIVING LICENSE OTHER(SPECIFY)
GAS TEST MANDATORY FOR ALL VEHICLE ENTRY INTO HAZARDOUS AREAS
GAS TEST LEL LEL % LEL % LEL % LEL %
%

TIME

CHECKED BY
ANY TIME A CRANE IS USED NOTE INSPECTION EXPIRATION DATE
ADDITIONAL PRECAUTIONS & CONDITIONS:DRIVER MUST REMAIN WITH THE VEHICLE AT ALL TIMES WHILST IN THE HAZARDOUS AREA

SECTION 3 – ISSUE CERTIFICATE

WE THE UNDERSIGNED HAVE PERSONALLY INSPECTED THE JOB SITE AND AUTHORIZE THE VEHICLE AND/OR EQUIPMENT ENTRY TO PROCEED IN ACCORDANCE
WITH THESE CONDITIONS. ANY CHANGE IN THESE CONDITIONS WILL INVALIDATE THIS CERTIFICATE.
ISSUIING AUTHORITY PERFORMING AUTHORITY

SIGN DATE/TIME SIGN DATE/TIME

SECTION 4 – COMPLETION
WE THE UNDERSIGNED DECLARE THAT THE AREA HAS BEEN LEFT SAFE, CLEAN AND TIDY. THE VEHICLE/EQUIPMENT HAS BEEN REMOVED FROM THE WORK
AREA.
PERFORMING AUTHORITY ISSUING AUTHORITY

SIGN DATE/TIME SIGN DATE/TIME

ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc No: HSE/FRM-16
Rev: 00
CONFINED SPACE ENTRY CERTIFICATE Date of Rev: 22-June-2016
Page: 1 of 2

LOCATION EQUIPMENT DURATION OF ENTRY

HOT WORK PERMIT COLD WORK GAS TEST CERTIFICATE ISOLATION CERTIFICATE
PERMIT
NOTES: ALL ITEMS MUST BE RECHECKED IF THE ENTRY SUPERVISOR CHANGES, SHIFT CHANGE OCCURS, OR SPACE REMAINS EMPTY FOR MORE
THAN 60 MINUTES.
ALL INFORMATION MUST BE COMPLETED PRIOR TO ENTRANCE.
DISCREPANCIES IDENTIFIED DURING ENTRY OR DEBRIEFING SHALL BE LISTED ON THE BACK
LOCATION & PURPOSE OF ENTRY

ENTRY SUPERVISOR/SBM NAME: SIGN. :

GAS TESTING REQUIREMENTS

Immediately Before Work Commences Continuous during work progress every
…………….. hours
REQUIRED PRECAUTIONS & ENTRY CONDITIONS HAZARDS IDENTIFIED LIST COMMUNICATION METHODS

YES N/A YES N/A

CONTENTS OF CONFINED SPACE REMOVED TOXIC
ATMOSPHERE
ALL CHEMICALS, UTILITY AND OUTLET LINES CORROSIVE
ISOLATED MATERIALS
CONFINED SPACE PURGED/FLUSHED WITH: INADEQUATE
WATER LIGHT
AIR/ Nitrogen DUST OR FUME

EQUIPMENT COOLED FOR ENTRY OXYGEN

DEFICIENCY
ADEQUATE LIGHTING OXYGEN
ENRICHMENT
SPACE HAS BEEN DETERMINED SAFE TO OPEN HEAT/COLD/WEA
THER
ATMOSPHERIC TESTING CONDUCTED (O2, LEL, FALLING
TOXIC) OBJECTS.
CONTINUOUS MONITORING ESTABLISHED CHEMICAL PERSONAL PROTECTIVE EQUIPMENT
REACTIVITY
ISOLATION COMPLETE/BLANKS LIST ATTACHED SLUDGE/RESIDU YES N/A
E.
MANWAYS & OPENINGS IDENTIFIED & BIOLOGICAL RETRIEVAL LINE
UNOBSTRUCTED
ATTENDANT(S) ASSIGNED AND PRESENT CHEMICAL FULL BODY HARNESS
CONTACT
HARNESS & LIFELINE WORN & ATTACHED HOT/COLD SCBA
CONTACT
RESCUE STRATEGY AND RESCUE SERVICE READY SHARP OBJECTS GAS /VAPOR MASK
RESPIRATORY PROTECTION REQUIRED FOR MIGRATING OTHERS :
ENTRY VAPORS/GASES
MECHANICAL VENTILATION REQUIRED OTHERS:

BARRICADES & TAGS IN PLACE SPECIFY:

ENTRY BRIEFING CONDUCTED – TOOL BOX HAZARDS BEING INTRODUCED BY NATURE OF WORK
DISCUSSION (INCLUDING COATINGS, PAINTS, WELDING FUMES, ETC.)
LIST RESCUE EQUIPMENT

DOCUMENT ATMOSPHERIC TESTING REQUIRED TO MAINTAIN A SAFE ATMOSPHERE

DATE TIME LEL% H2S PPM O2 % OTHERS CHECKED BY

ISSUE PERMIT
WE THE UNDERSIGNED HAVE PERSONALLY INSPECTED THE JOB SITE AND AUTHORIZE THE WORK TO PROCEED IN ACCORDANCE WITH THESE CONDITIONS. ANY
CHANGE IN THESE CONDITIONS WILL INVALIDATE THIS PERMIT.

ISSUING AUTHORITY PERFORMING AUTHORITY & CONTRACTOR HSE DEPARTMENT

REP.
SIGN: SIGN: / SIGN:

DATE: DATE: / DATE:

TIME TIME: / TIME:

EXTENSION / COMPLETION
JOB COMPLETED YES / NO WORK PERMIT EXTENDED YES / NO EXTENDED UPTO: Hrs

SIGN(ISSUER):

I HAVE PERSONALLY VERIFIED ALL ENTRANTS HAVE EXITED THE SPACE, CONDUCTED A DEBRIEFING WITH THE PERSONNEL, AND CANCEL THIS PERMIT

PERFORMING AUTHORITY & CONTRACTOR REP. JOB COMPLETED HANDED BACK TIME DATE

SIGN: YES / NO YES / NO

ISSUING AUTHORITY EQUIPMENT ACCEPTED BACK TIME DATE

SIGN: YES / NO

ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc No: HSE/FRM-16
CONFINED SPACE ENTRY CERTIFICATE Rev: 00
Date of Rev: 22-June-2016
Page: 2 of 2

CONFINED SPACE ENTRY LOG

EMERGENCY  NOTIFY ATTENDANT BEFORE ENTERING PERMIT SPACE. SBM Name:
CONTACT #  SIGN IN IMMEDIATELY PRIOR TO ENTRY. Date
 CROSS OUT NAME, AND INITIAL OUT UPON LEAVING PERMIT SPACE. Location

Serial Name ATTENDANT’S INITIALS IN TIME IN ATTENDANT’S INITIALS TIME OUT

# OUT
1

26
Doc No: HSE/FRM-17
Rev: 00
EXCAVATION CERTIFICATE Date of Rev: 22-June-2016
Page: 1 of 1

LOCATION: SECTION ASSOSSIATED

WORK PERMIT
NO.
WORK DESCRIPTION ZONE 0 1 2
CLASSIFICATION
REASON FOR EXCAVATION

CERTIFICATE POSITION
ORIGINATOR
DURATION DATE FROM TO HRS
HRS
SECTION 1 – PREPARATION CHECK LIST

ITEMS COMMENTS
DRAWINGS HAVE BEEN ATTACHED YES NO DRAWING NOS.
USE OF MECHANICAL EQUIPMENT YES NO

ALL KNOWN & IDENTIFIED SERVICES ARE MARKED IN THE FIELD USING YES NO
WOODEN PEGS
CONFINED SPACE ENTRY CERTIFICATE REQUIRED - DEPTH (> 5 FEET) YES NO

GAS TESTS – DEPTH (> 5 FEET) YES NO

TRENCH SIDES SLOPED BACK YES NO

BENCHING, SHORING REQUIRED YES NO

NEAREST APPROACH TO EXISTING FOUNDATIONS (> 2 X DEPTH) YES NO

LADDERS MIN. 3 FEET ABOVE SURFACE LEVEL AND SECURED YES NO

ADEQUATE BARRIER/ BARRICADE, SAFET SIGN BOARDS AND LIGHTING FOR YES NO CHECKED/APPROVED BY YES NO
NIGHT TIME WORKING PROVIDED
LINE LOCATOR REQUIRED AND SWEEP CONDUCTED YES NO CABLES (ELECTRICAL /
INSTRUMENTS)
STANDBY MAN IN POSITION YES NO SEWER

EXCAVATED MATERIALS WILL KEEP 1 METER AWAY FROM EXCAVATION YES NO MECHANICAL -
PIPELINES
NECESSARY PPE’S PROVIDED TO WORKERS (RUBBER BOOTS, DUST MASKS & YES NO TELECOM -CABLES
GLOVES WITH OTHER MANDATORY PPE’S)
OTHER PRECAUTIONS AND ACTIONS IN CASE OF ANY DAMAGE:

NOTE: NO EXCAVATION WORK IS PERMITTED DURING HIGH WINDS OR HEAVY RAIN

I THE AREA AUTHORITY HAVE CHECKED THAT THE REQUIREMENTS ABOVE HAVE BEEN ADDRESSED.

SIGNED PRINTED NAME DATE/TIME

SECTION 2 – ISSUE CERTIFICATE

GAS TEST RESULTS DATE TIME RESULTS SIGNED

I THE ISSUEING AUTHORITY HAVE PERSONALLY INSPECTED THE JOB SITE AND AUTHORIZE THE WORK TO PROCEED IN
ACCORDANCE WITH THESE CONDITIONS. ANY CHANGE IN THESE CONDITIONS WILL INVALIDATE THIS PERMIT.
SIGNED PRINTED NAME DATE/TIME

I THE PERFORMING AUTHORITY UNDERSTAND AND WILL ADHERE TO THE PRECAUTIONS AND REQUIREMENTS OF THE
EXCAVATION CERTIFICATE.
SIGNED PRINTED NAME DATE/TIME

SECTION 3 – COMPLETION
I THE PERFORMING AUTHORITY DECLARE THAT THE AREA HAS BEEN SAFE, CLEAN AND TIDY. THE WORK IS
COMPLETE NOT COMPLETE TIME DATE

SIGNED PRINTED NAME

I THE ISSUEING AUTHORITY DECLARE THAT THE AREA HAS BEEN LEFT SAFE, CLEAN AND TIDY. THE WORK IS-
HANDED BACK ONGOING TIME DATE

SIGNED PRINTED NAME

ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc No: HSE/FRM-18
Rev: 00
RADIOGRAPHY CERTIFICATE Date of Rev: 22-June-2016
Page: 1 of 1

LOCATION: SECTION EQUIPMENT Tag #

EQUIPMENT/ PIPELINE ZONE CLASSIFICATION 0 1 2

DESCRIPTION

REASON FOR ASSOCIATED WORK

RADIOGRAPHY PERMIT #

JOB INITIATOR POSITION ISOLATION

CERTIFICATE #
HRS Hrs
DURATION DATE FROM TO

DESCRIPTION OF WORK

RADIOGRAPHER SAFE DISTANCE FOR BARRICADE

TYPE OF SOURCE STRENGTH OF SOURCE

SPECIFIC PPE’s

SECTION 1 – PREPARATION CHECK LIST

PRECAUTIONS INITI ADITIONAL PRECAUTIONS

LIMITS OF RESTRICTED AREA IS BARRACADED OFF YES NO PPE FOR RADIOGRAPHY

WARNING SIGNS AND NOTICES POSTED YES NO

UNAUTHORISED PERSONS INFORMED OF DANGERS YES NO

NO UNAUTHORISED PERSON IN RESTRICTED AREA YES NO

AUTHORISED PERSONNEL WEAR FILM BADGE YES NO

OTHERS YES NO

I THE AREA AUTHORITY HAVE CHECKED THAT THE REQUIREMENTS ABOVE HAVE BEEN ADDRESSED.

SIGNED PRINTED NAME DATE/TIME

SECTION 2 – ISSUE CERTIFICATE

I THE ISSUING AUTHORITY HAVE PERSONALLY INSPECTED THE JOB SITE AND AUTHORIZE THE WORK TO PROCEED IN ACCORDANCE
WITH THESE CONDITIONS. ANY CHANGE IN THESE CONDITIONS WILL INVALIDATE THIS PERMIT.

SIGNED PRINTED NAME DATE/TIME

I THE PERFORMING AUTHORITY UNDERSTAND AND WILL ADHERE TO THE PRECAUTIONS AND REQUIREMENTS OF THE
RADIOGRAPHY CERTIFICATE.

SIGNED PRINTED NAME DATE/TIME

SECTION 3 – COMPLETION
I THE PERFORMING AUTHORITY DECLARE THAT THE AREA HAS BEEN LEFT SAFE, CLEAN AND TIDY AND THE WORK IS COMPLETE

COMPLETE TIME DATE

SIGNED PRINTED NAME

I THE ISSUING AUTHORITY DECLARE THAT THE AREA HAS BEEN LEFT SAFE, CLEAN AND TIDY.AND THE WORK IS HANDED BACK

HANDED BACK TIME DATE

SIGNED PRINTED NAME

ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc No: HSE/FRM-19
Rev: 00
Date of Rev: 22-June-2016
GAS TEST CERTIFICATE Page: 1 of 1

LOCATION EQUIPMENT DATE/TIME

HOT WORK PERMIT # COLD WORK PERMIT # CONFINED SPACE ENTRY CERTIFICATE VEHICLE ENTRY CERTIFICATE #
#
JOB SUPERVISOR POSITION NAME OF GAS TESTER

SECTION 1 GAS TEST EQUIPMENT

LIST ATMOSPHERIC MONITORING EQUIPMENT BELOW WITH SERIAL NUMBER

EQUIPMENT SERIAL NUMBER DATE OF

CALIBRATION

SECTION 2 GAS TESTER

I THE COMPENTENT GAS TESTER DECLARE THE AREA TESTED INDICATES THE ATMOSPHERE IS SAFE FOR WORK TO COMMENCE.

NAME POSITION DATE OF CERTIFICATION

SIGNATURE DATE TIME

SECTION 3 GAS TEST RESULTS

RESULTS TIME INITIALS RESULTS TIME INITIALS RESULTS TIME INITIALS

OXYGEN (O2)

FLAMMABLE GAS (LEL)

HYDORGEN SULPHIDE (H2S)

CARBON DIOXIDE (CO2)

OTHER TOXIC GASES (SPECIFY)

OXYGEN (O2)

FLAMMABLE GAS (LEL)

HYDORGEN SULPHIDE (H2S)

CARBON DIOXIDE (CO2)

OTHER TOXIC GASES (SPECIFY)

OXYGEN (O2)

FLAMMABLE GAS (LEL)

HYDORGEN SULPHIDE (H2S)

CARBON DIOXIDE (CO2)

OTHER TOXIC GASES (SPECIFY)

OXYGEN (O2)

FLAMMABLE GAS (LEL)

HYDORGEN SULPHIDE (H2S)

CARBON DIOXIDE (CO2)

OTHER TOXIC GASES (SPECIFY)

ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc No: HSE/FRM-20
Rev: 00
Heavy Lift Certificate Date of Rev: 22-June-2016
Page: 1 of 1

DESCRIPTION OF ISOLATION
LOCATION EQUIPMENT TAG EQUIPMENT
DETAILS
REASON FOR HEAVY LIFT Zone Classification

Equipment to be Used 0 1 2

Associated Permit & # Any Associated Certificate

Crawler crane RT Crane Forklift Chain block Mono Crane

Anticipated Date Time Anticipated Date Time

Commencement Completion

PREPARATION CHECKLIST
Checklist Filled by performing Authority Checklist Filled by performing Authority

weight to be lifted Weight to be lifted

Crane Boom Angle & Radius Crane radius barricade

Wind Speed & direction Safe Work load of Equipment

Rigging Gear Certified Condition of ground

Equipment Third Party certified Rigger 3rd Party certified

Operator 3rd Party certified Load Pass over Process

Equipment/Pipeline
Rigging Study required Other Precautions

ISSUE
We undersign have ensured that the work site has been inspected and authorize the weight to be lifted in accordance with above
conditions. The job can only begin when endorsed by Area Authority

Performing Authority Area Authority Issuing Authority

Name Name Name
Sign Sign Sign
Date Time Date Time Date Time
COMPLETION OF JOB
In liaison with the area authority, we have been inspected the worksite, the above heavy lifting work has been completed, the area
has been left safe, clean, and tidy, upon completion all guards and tools and materials have n=been removed.
Performing Authority Area Authority Issuing Authority
Name Name Name
Sign Sign Sign
Date Time Date Time Date Time
ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc. No. HSE/FRM-21
Rev 00
Electrical / Mechanical Isolation Date of Rev.:22-June-2016
Page No. 1 of 1
Certificate
Description of Isolation
Location/Installation Original Associated Work
Permit No:
Equipment to be isolated Work Continuing on
Permit No:
Tag no: P&IDs / SLD Attached Yes/No
Reason for Isolation:

Isolation Request (By requester) De‐Isolation Request (By requester)

I hereby certify that work is sufficiently completed for de‐isolation.
Contractor/ Dept: Contractor/ Dept.:

Name: Signature: Date/Time: Name: Signature: Date/Time:

Details of Mechanical/ Process Isolation (By Isolation Authority)

Isolation Valve Valve Isolation De‐Isolation Comments/ Special
Point No. Tag / Initial Valve Spade/Blind Disconnect Valve Spade/Blind Reconnect Precautions
Line No. State Inserted Removed
O C O C O C

Details of Electrical Isolation (By Isolation Authority)

Isolation Electrical Equipment Isolation Padlock Lockout Box
Isolation Method Fuse Removed
Point No: Equip. ID No: Point No: No:

Isolation De‐isolation
I hereby authorize the isolation(s) as described in Section 3 I hereby authorize the removal of isolation(s) as described in
Section 3
Issuing Authority Name: Signature: Date/Time:
Issuing Authority Name: Signature: Date/Time:

I hereby certify the isolation(s) have been applied as described in I hereby certify the isolation(s) have been removed.
Isolating Authority Name: Signature: Date/Time: Isolating Authority Name: Signature: Date/Time:

I hereby certify that isolation(s) are in place and proven. I hereby confirm that isolation(s) have been removed and site has
been returned to its initial state.
Area Authority Name: Signature: Date/Time: Area Authority Name: Signature: Date/Time:

Extended Period Isolation (This section is to be completed when this certificate remains in force without an associate Permit)
Reason For EPI:
EPI ON EPI OFF
No. of Closed‐out Permit ___________ No. of New Permit ___________
EPI Authorized by Issuing Authority Removal of EPI Authorized by Issuing Authority

Issuing Authority Name Signature: Date/Time: Issuing Authority Name Signature: Date/Time:

ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc No: HSE/FRM-21A
Rev: 00
Mechanical /Process Isolation Continuation Certificate Date of Rev: 22-June-2016
Page: 1 of 1

Section Continuation - Details of isolation (by Isolating Authority)

Isolation Deisolation
Valve Initial
Isolation Point Valve State Comments/ Special Precaution/Padlock
Valve Valve Spade /
No. Tag No. Spade/Blind No.
Disconnect Blind Reconnected
Inserted
O C O C O C Removed
Doc No: HSE/FRM-22
Rev: 00
SAFETY SYSTEM DEFEAT CERTIFICATE Date of Rev: 22-June-2016
Page: 1 of 1

DESCRIPTION OF DEFEAT

LOCATION: SECTION EQUIPMENT

WORK DESCRIPTION ZONE CLASSIFICATION 0 1 2

EQUIPMENT TAG ASSOCIATED WORK PERMIT #

PURPOSE OF
SAFETY SYSTEM

REASON FOR DEFEAT

EFFECT OF SAFETY SYSTEM DEFEAT

METHOD OF BYPASS/OVERRIDE

DEFEAT IMPLEMENTATION REQUEST (Name) Sign Date/Time

DEFEAT REMOVAL REQUEST Sign Date /Time

DETAILS OF SAFEGUARDS
REQUIRED

BYPASS/OVERRIDE DIAGRAM
DESCRIPTION

SECTION 1 – PREPARATION CHECK LIST

PRECAUTIONS INITIAL ADITIONAL PRECAUTIONS

BYPASS/OVERIDE ACTIVATION IS POSITIVELY IDENTIFIED ON SITE YES NO

BYPASS/OVERIDE DETAILS ENTERED IN LOG YES NO

CONTROL ROOM OPERATOR ADVISED YES NO

BYPASS/OVERIDE REMINDER POSTED IN CONTROL ROOM YES NO

BYPASS/OVERIDE LOCKS AND TAGS INSTALLED YES NO

YES NO

I THE AREA AUTHORITY HAVE CHECKED THAT THE REQUIREMENTS ABOVE HAVE BEEN ADDRESSED.

SIGNED NAME DATE/TIME

SECTION 2 – ISSUE CERTIFICATE

I THE ISSUING AUTHORITY HAS PERSONALLY INSPECTED THE JOB SITE AND AUTHORIZE THE WORK TO PROCEED IN ACCORDANCE
WITH THESE CONDITIONS. ANY CHANGE IN THESE CONDITIONS WILL INVALIDATE THIS PERMIT.

SIGNED NAME DATE/TIME

I THE COMPETENT MAINTENANCE AUTHORITY UNDERSTAND AND WILL ADHERE TO THE PRECAUTIONS AND REQUIREMENTS OF THE
BYPASS/OVERRIDE CERTIFICATE.

SIGNED PRINTED DATE/TIME

NAME

SECTION 3 – COMPLETION
I THE MAINTENANCE AUTHORITY DECLARE THAT THE AREA HAS BEEN LEFT SAFE, CLEAN AND TIDY AND THE WORK IS COMPLETE

COMPLETE TIME DATE

SIGNED PRINTED NAME

I THE ISSUING AUTHORITY DECLARE THAT THE AREA HAS BEEN LEFT SAFE, CLEAN AND TIDY.AND THE WORK IS HANDED BACK

HANDED BACK TIME DATE

SIGNED PRINTED NAME

ORIGINAL COPY
DISPLAYED AT WORKSITE ISSUING AUTHORITY
Doc No: HSE/FRM-23
Rev: 00
Safety System Defeat Register Date of Rev: 22-June-2016
Page: 1 of 1

Project Name: _________________________ Project Number : __________________________ Project Phase :________________________ Location:_____________________

Safety System Isolating Authority Overide / Date / Time Transfer to

Associated Approving Date / Time Commissioning Commissioning EPI
Defeat Certificate (Person Applying Inhibit / Defeat Description/ Reason Defeat Extend Period
Permit No. Authority Defeat Applied Operator Sign Operator Sign Cancelled
No. Defeat) Defeat Removed of Isolation
Doc No: HSE/FRM-24
Rev: 00
Permit To Work Logbook Date of Rev: June22, 2016
Page: 1 of 1

Project Name:_____ Project Number:

Serial
Permit # Type of Permit Description of Permit Issuing Authrity Receiving Authority Remarks
No.

PTW Coordinator HSE Engineer Project / Site Manager

_ _______________

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