Permit Review By Date Hot Work Permit Number
Permit Review By: Date: Hot Work Permit Number: Contractor Name Information to be completed by Permit Requestor/Holder Company: Meraux Refinery Area/Unit Permit Holder: Equipment # # Persons: Tools/Equipment to be used: q Hand tools q Lift trucks q. Double Insulated Work Order #: Scope of Proposed Task: Electric Other: Please initial that the Scope of work is clear and understood. Permit Holder: Permit issuer: Information to be completed by Permit Issuer. (Must be Chief Operator) MSDS Yes Checked N/A Previous Product in Equipment: Equipment Pre-Work LOTO Procedures Followed • Blinded/Disconnected • Equipment Opened/Depressurized • Valves. Closed/Tagged/Chained/Locked • De-energized Electrical Systems • Electrically Locked/tagged out • Field Test / Attempt to Energizestart Blinds Verified & Blind-List initialed Job Hazards Y Additional PPE Required? Req’d Done Y -- N Equipment Pre-Work Lock Box Number: Decontamination Req’d Done Y -- N Area Preparation Trained Fire-Watch • Orange Vest Y -- N • Water Washed Y -- N • Signal Horn Y -- N • N 2 Purged Y -- N • Fire Extinguisher Y -- N • • Steamed Other Y -- N Area “Wet Down” Sumps-drains covered Y -- N Radioactive Sources Secure Y -- N Contained Sparks Y -- N 120 V Electrical equip GFCI Y -- N Standard Controls Job Hazards Static Electricity Grounding, Slips, Trips & Falls Chemical /Fuel Exposure Vehicle Entry in the unit? Housekeeping, & PPE MSDS Review, PPE Overhead Hazards Procedures, Barriers, & Permit Sharp Edges Electricity Isolation, LOTO, GFCI Activities of Others Flammable Vapors / liquid Gas Testing & Isolation Access & Egress Housekeeping, Walkways, Stairs Trapped Pressure Venting, Draining, & PPE Weather Extremes Schedule, breaks. Spillage to Ground Spillage to Water Secondary Containment / Booms • • Y -- N Y -Clean-up Oil in Area Y -PPE Y -Y Standard Controls Additional Fire Equipment Y -Assessment & lifting. Additional equipment. Standby Standard (SSP 0011) Covers, Isolation, & Maintenance Full Face Shield Manual Handling / Lifting Moving Parts Respirator / Eye Fumes & Dust Protection Insulation / Barriers / Hot Surfaces PPE Specific Hazards: Toxic Vapors / Gas Testing & Isolation Liquids Excavation Checklist Req’d Done Y -- N Labelling, Isolation, & Barriers N N N Req’d N Y -- N Goggles Covers, PPE, & Equipment Inspections Communications, Barriers, Permit Y -- N Hearing Protection Y -- N Hi-Vis Clothing, Speed Limit, & Vehicle Traffic Signs Additional Controls and/or Special Instructions CAT Testing, Labelling, & Underground Hazards Barriers Hot Liquid Procedures & PPE Scaffolding & Fall Protection / Working at Height Harness Working Over Water Life Jacket, & Safety Boat, Mechanical Lifting Barriers / Lift Procedures Fall Protection Y -- N Leather Gloves Y -- N Rubber Gloves Y -- N Non Permeable Suit Y -- N Respirator ½ face Y -- N Respirator Full Face Y -- N Filter Type: Supplied Air Y -- N Personal H 2 S Y -- N monitor Signing this Hot Work Permit signifies the job site has been inspected by the Permit Issuer and Permit Requester/ Holder, the. Apparel area is prepared, Y -- N Welding and each individual has agreed to comply with the conditions of this permit. HF Alky -- LEVEL The Permit is valid through the end of the current work shift (start and end times below) and may be extended into the next shift if necessary. “A”: Totally encapsulated suit – positive pressure Test 1 Test 2 Test 3 Date Test 4 All Signatures are Required PRIOR to Hot Work Start. Authorized Time LEL Unit Operator H 2 S Fire Watch Other Authorized Time Start Time Expires Print Name Signature Date Permit Holder Serial # Permit Issuer (Chief Operator) Calibrated? Unit Operator Initial -- Meraux Qualified Person Fire Watch Work Safe/Clea Expose HF PPE Comple n Jobd Cleaned te Site? HF Acid ? Y N Y N One Piece Coverall, HF Boots, Gloves w/sealed Cuffs/ face shield All Signatures are Required PRIOR to EXTENDING permit into the following shift. Benzene One piece coverall, gloves w/sealed cuffs, HF boots, positive flow hood w/ air line. HF Alky -- LEVEL Date Signature “C”: Print Name Permit Issuer (Chief Operator) CO Permit End Time Expires Permit Holder Oxygen Permit Holder Unit HF Alky -- LEVEL Time Start “B”: Y N Print Name Signature Date Time
Permit Number will be pre-printed on form The Permit Holder completes this section of the permit prior to meeting wit permit issuer. Check if Meraux personnel doing work Check and indicate Contractor Name for contractor work Person responsible for directly supervising the work. How many will be Indicate work involved performing order numbers work The Permit Holder should describe the scope of work to be completed in this area. Indicate product last in vessel so proper PPE can be assessed. . << Indicate if the MSDS was checked for the previous product in the vessel and any additional PPE required. The Permit Issuer and Permit Holder work through this section to ensure that: 1 – all Equipment Pre-Work area are checked to indicate what is REQUIRED (Req’d) 2 – to ensure that all REQUIRED Pre-Work is actually DONE The permit issuer and Permit Holder also ensure area preparation is required and Done for Bottle Watch or Low Energy Work. The Permit Issuer and Permit Holder also inspect the area for Job Hazards. In this area if a Job Hazard exists the box should be checked. Standard Controls or other appropriate measures should be taken to ensure the area is safe for work. Also – potential Environmental impacts are noted below: Identify any additional or specific Hazards of explanations of certain above information. List tools & equipment to be used. Clarify additional controls or special instructions for the work. . A Meraux employee (or designated contractor during turnaround events) who is qualified to do air testing must test the work area prior any HOT work and must take additional samples during the course of the work. A separate form for tracking confined space entry and other required will also be required. If HF Exposure– indicate and Based on the work and hazards – specific required PPE should be Identified for the permitted work. If HF Alky involved indicate PPE Level These names, signatures and date must be complete and the Start and End time for the permit set (above) prior to work start. If, at the end of the shift, it is necessary to extend the permit, the on-coming Permit Holder and Issuer must review the area to ensure conditions have not changed and re sign the permit with start and end times. When the work is complete the Permit Holder and the Unit Operator should review the work and indicate whether it is complete and the site is in Safe condition – then print and sign their name, date and time on the form.
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