11 Safe Workg Permit
2
ALLIANZ MIDDLE EAST SHIP MANAGEMENT LLC SAFE WORK PERMIT - VESSEL TYPE: HOT WORK CONFINED SPACE COLD WORK A DESCRIPTION OF WORK TO BE PERFORMED SHIP : LOCATION : NOTE: Gas test must be carried out immediately pri FLAMMABLES H2S CO CL3 O2 TESTER'S SIGNATURE REQUIREMENTS FOR SAFE WORKING CONDITIONS 1. IN SERVICE ……….....…...................…..… 19. FOAM PROTECTION ........................…… 2. SHUT DOWN ………...…….........…..………....…. 20. BLANKETED WITH ............................ 3. DEPRESSURIZED .………..................…....... 21. CONTINUITY BONDING REQUIRED ............... 4. DRAINED ……………….............................. 22. MECH. ISOLATION CHECK LIST ATTACHED ....... 5. OPEN ......................................… 23. ISOLATED MECHANICALLY & TAGGED BY: 6. EMPTY ...................................... a. blanking/spading ................… 7. FULL OF .................................... b. disconnecting ................…... 8. PRESSURIZED WITH ........................... c. valving .......................... 9. GAS FREE ................................... 24. CO2/HALON LOCKED OFF/ISOLATED ............. 10. VENTILATED ................................. 25. FUEL GAS BLINDED ...................…...... 11. STEAMED .................................... 26. ELEC. CIRCUITS ISOLATED & TAGGED .......... 12. WATER FLUSHED .............................. 27. SAFETY DEVICE/SYSTEM LOCKED ............... 13. INERTED WITH ............................... 28. EQUIPMENT IS HOT .................…........ 14. FIRE WATCH REQUIRED ....................... 29. PORTABLE FIRE WATER MONITOR ............... 15. PORTABLE GAS MONITOR REQUIRED .......… 30. PORTABLE FIRE EXTINGUISHER AT SITE ........ 16. FIRE NET WORK UNDER PRESSURE .........… a. CO2 ............................……. 17. FIRE HOSE LENGTHENED ...................... b. Halon ............................. 18. PORTABLE FIRE ALARM POSITIONED ........… c. Dry chemical powder ............... DIVING SUPERVISOR CHIEF ENGINEER MASTER B CONTRACTOR/PERFORMER/COMPANY NAME: SIGNATURE : 1. PROTECTIVE CLOTHING TO BE WORN .…...… 8. ESCAPE ROUTE CLEARED/PROVIDED .............. 2. GOGGLES/FACE-SHIELD ........................ 11. ESCAPE MASK STANDBY .....................….. 3. EAR MUFFS .................................. 12. LOW SPARKING TOOLS ........................… 4. HAND PROTECTION ............................ 13. FLAME RETARDANT PARTITION ...........…...... 5. LIFE JACKET ................................ 14. BARRIERS & WARNING SIGNS INSTALLED ......... 6. SAFETY BELT/HARNESS & LIFELINE ......…..… 15. ADEQUATE LIGHTING/SEARCH LIGHTS ............ 7. COMBUSTIBLE MATERIAL CLEARED .....…....... 16. H2S TRAINED PERSONNEL ONLY ................. 9. FRESH AIR MASK/SCUBA TO BE WORN .…..… 17. MATERIALS IN VICINITY INCLUDING OTHER 10. SEWERS, DRAINS, GUTTERS, ETC. WITHIN FLOORS & LEVELS PROTECTED FROM 15M (50FT) OF WORK SITE SEALED ......…....… FLAMES AND SPARKS ........................ C AUTHORIZATION FOR WORK I hereby declare that all the safety requirements have been implemented and I autho MASTER OF VESSEL : Starting at ...................... hours Date: ......................... Signature: .................... D WORK COMPLETION I hereby declare that the work detailed in this permit has been complet every person assigned has been withdrawn. The equipment is/is not in a condition to be returned to se Name Date Tim Signature PERFORMING AUTHORITY ACKNOWLEDGED BY MASTER Form No. SMS/11/Rev. 1 Date: 06/07/2014 GAS TEST Required SHIP MASTER CONTRACTOR/PERFORMER Y N N N N
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Transcript of 11 Safe Workg Permit
ALLIANZ MIDDLE EAST SHIP MANAGEMENT LLCSAFE WORK PERMIT - VESSEL
TYPE:HOT WORK CONFINED SPACE
COLD WORKA DESCRIPTION OF WORK TO BE PERFORMED SHIP : LOCATION :
NOTE: Gas test must be carried out immediately prior to commencement of work.
FLAMMABLES H2S CO NH3 CL3 O2 TESTER'S SIGNATURE TIME
REQUIREMENTS FOR SAFE WORKING CONDITIONS
1. IN SERVICE ……….....…...................…..…….…. 19. FOAM PROTECTION ........................……...............................
2. SHUT DOWN ………...…….........…..………....…. 20. BLANKETED WITH .................................................….............
3. DEPRESSURIZED .………..................…...........… 21. CONTINUITY BONDING REQUIRED .......................…........…
4. DRAINED ………………....................................… 22. MECH. ISOLATION CHECK LIST ATTACHED ...................…
5. OPEN ......................................…........................... 23. ISOLATED MECHANICALLY & TAGGED BY:
6. EMPTY ........................................…....................... a. blanking/spading ................….................……...................
7. FULL OF ............................................................... b. disconnecting ................…...........................…..................
8. PRESSURIZED WITH .....................................…. c. valving ....................................……...................…..............
9. GAS FREE ............................................................ 24. CO2/HALON LOCKED OFF/ISOLATED ..............................…
10. VENTILATED ....................................................... 25. FUEL GAS BLINDED ...................….........................................
11. STEAMED ............................................................ 26. ELEC. CIRCUITS ISOLATED & TAGGED ..............................
12. WATER FLUSHED .............................................. 27. SAFETY DEVICE/SYSTEM LOCKED ......................................
13. INERTED WITH ................................................… 28. EQUIPMENT IS HOT .................…...........................................
14. FIRE WATCH REQUIRED ..............................… 29. PORTABLE FIRE WATER MONITOR .....................................
15. PORTABLE GAS MONITOR REQUIRED .......… 30. PORTABLE FIRE EXTINGUISHER AT SITE .................……
16. FIRE NET WORK UNDER PRESSURE .........… a. CO2 ............................……......................….......................
17. FIRE HOSE LENGTHENED .............................… b. Halon .................................……................…......................
18. PORTABLE FIRE ALARM POSITIONED ........… c. Dry chemical powder .................................…….................
DIVING SUPERVISOR CHIEF ENGINEER MASTER
B CONTRACTOR/PERFORMER/COMPANY NAME: SIGNATURE :
1. PROTECTIVE CLOTHING TO BE WORN .…...… 8. ESCAPE ROUTE CLEARED/PROVIDED ...................................
2. GOGGLES/FACE-SHIELD ................................… 11. ESCAPE MASK STANDBY .....................…................................
3. EAR MUFFS .......................................................... 12. LOW SPARKING TOOLS ........................…...............................
4. HAND PROTECTION ............................................ 13. FLAME RETARDANT PARTITION ...........…............…...........…
5. LIFE JACKET ....................................................…. 14. BARRIERS & WARNING SIGNS INSTALLED ...........................
6. SAFETY BELT/HARNESS & LIFELINE ......…..… 15. ADEQUATE LIGHTING/SEARCH LIGHTS .................................
7. COMBUSTIBLE MATERIAL CLEARED .....…....... 16. H2S TRAINED PERSONNEL ONLY ..........................................
9. FRESH AIR MASK/SCUBA TO BE WORN .…..… 17. MATERIALS IN VICINITY INCLUDING OTHER
10. SEWERS, DRAINS, GUTTERS, ETC. WITHIN FLOORS & LEVELS PROTECTED FROM
15M (50FT) OF WORK SITE SEALED ......…....… FLAMES AND SPARKS ...........................…................................
C AUTHORIZATION FOR WORK I hereby declare that all the safety requirements have been implemented and I authorize the work to be carried out.
MASTER OF VESSEL : Starting at ...................... hours Date: ......................... Signature: ......................................
D WORK COMPLETION I hereby declare that the work detailed in this permit has been completed/stopped in a safe condition and
every person assigned has been withdrawn. The equipment is/is not in a condition to be returned to service with the exception of …………..…..
Name Date Time Signature
PERFORMING AUTHORITY
ACKNOWLEDGED BY MASTER
Form No. SMS/11/Rev. 1 Date: 06/07/2014
GAS TEST Required
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