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HSE PROCEDURE Doc. No. NUS-HSE-PTW/01

Rev 01
PERMIT TO WORK PROCEDURE Date 10/11/2014

HOT WORK PERMIT

N :________
o

PERMIT INITIATION
Initiator: ID No :

Date: Start: Finish:

Location: No of workers: Vehicle No:

Work Description : Tools:

Rig Manager Rig Manager

Remarks : Signature :

PRE WORK INSPECTION & HSE REQUIREMENTS

Presence of flammable/combustible Should fire system be bypassed
materials nearby Yes

No
Is Energy Lock- out Implemented : Yes Will gas be vented to atmosphere
(pneumatic/hydraulic/capacitance) N/A Yes

No
Fluid transfer Present : Should H2S precations be taken
Yes Yes

N/A No
Special precautions : (Always wear proper PPE)

Operator (doing the Fire Watchman Responsible Supervisor HSE Officer

Work) Signature : Signature: Signature:
Signature :

COMMUNICATION
Responsible Supervisor Phone No :
Operator Phone No :

CLOSE OUT
Job complete Yes Area cleaned Yes Safety system Yes
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HSE PROCEDURE Doc. No. NUS-HSE-PTW/01
Rev 01
PERMIT TO WORK PROCEDURE Date 10/11/2014

No No Reconnected No
Original Rig Manager Copy- Supervisor Copy- HSE Officer
Copy- designate person

Any person can invalidate this Work Permit if conditions are considered as unsafe.

1) Inform the manager in charge

2) Remove the site copy of permit
3) Return to manager in charge

CHECK LIST

1. Adequate escape route

2. Remove flammable & combustible materials
3. Trash removed
4. Isolation checked
5. Welding equipment grounded
6. Check fire equipment
7. Consider fire watch
8. Proper & Adequate ventilation
9. Check communications
10.Correct equipment identification
11.Check ladders/scaffolds
12.Proper PPE

Close out Permit with the Supervisor When Work is Complete