cold work permit 001
TRANSCRIPT
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Revision 0 AGP/HSE/SF/045
COLD WORK PERMIT
Work location :
Permit Validation FromDate:
ExpireTime :
Decription o! Work :
"a#ard Identied
$pecial Preca%tion
Permit is valid only if the conditions existing at the time of issuance continue. It expires upon occurrence(s) gas lea
$a!et& Mea%re 'E$ No N(
Necessary barricades, arning signs in place in the area
!orkers been inducted and safety oriented to the "ob being perform.
#$# held prior to start the ork.
Necessary Personal Protective equipments provided to the orkers.
%lagmen & banksmen assigned to control the traffic
Permit R*%eted +&:
En,ineer ( $%per-ior( $i,nat%re : Date :
)p.alt !oreman
C.ecked +&:
$a!et& O!!icer $i,nat%re : Date :
I%ed +&:
Pro/ect En,ineer $i,nat%re : Date :
PERMIT CLO$E O0T
Cloe o%t re*%eted +&:
I .a-e cloed t.e 1ork2remo-ed all material and made t.e area a!e
En,ineer( $%per-ior $i,nat%re : Date :
Cloe o%t area c.ecked +&:
$a!et& O!!icer $i,nat%re : Date :
Name o! Pro/ect ' PII#* !+ (#--# I/0#IN/, #1 !2#- 32IN2/- 2N3 +-$) 4#0 -2#
0as the ork area been inspected and reasonable precaution taken to ensure that no potentialha:ards exist;
I understand and agree that no ork is permitted other than that specified on this permit. I have check both permit and the "ob, and undersork and precaution to be folloed in completing the ork
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Permit Cloed +&:
Pro/ect En,ineer $i,nat%re : Date :
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emit No :
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, liquid spills
) Remark
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-5# IN +567N- 8&9
tand the nature and extend of the
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Time :