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HSE PROCEDURE
Doc. No. NUS-HSE-PTW/02
Rev 01
PERMIT TO WORK PROCEDURE
Date 10/112014

Cold WORK PERMIT

No:________

PERMIT INITIATION

Initiator: ID No :

Date: Start: Finish:

Location: No of workers: Vehicle No:
Work Description
Tools:

Rig Manager Remarks Rig Manager Signature :

Yes / No
Is any hot work (cutting, welding, grinding) to be carried out?
Has a hot work permit been issued?
Penetrations
Does the work require penetration of the non-combustible outer layer of the
panel?
If so what tools will be used to cut the panel?
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Checks OK No N/A Action Required?
1. Production staff have been advised
2. No heat producing equipment to be used
3. Fire extinguisher and/or fire hose reel accessible
4. Sprinklers and other fire protection equipment is
operational
5. Mechanical fastening of any fixtures
6. No electrical equipment or other potential ignition
sources to be installed on or adjacent to panels

Special precautions : (Always wear proper PPE)

Authorisation (Responsible Officer)

Operator (doing the Work) Fire Watchman Responsible Supervisor HSE Officer
Signature : Signature : Signature: Signature:
COMMUNICATION
Responsible Supervisor Phone No :
Operator Phone No :
CLOSE OUT

Job complete Yes Area cleaned Yes Safety system

No No Yes
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HSE PROCEDURE
Doc. No. NUS-HSE-PTW/02
Rev 01
PERMIT TO WORK PROCEDURE
Date 10/112014

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