Hot Permit

Accelerated Carbon Capture and Sequestration (ACCS) PROJECT
Daily Validation of Hot Work Permit
HOT WORK PERMIT NO. HWP-

DATE DURATION(TIME) ACTIVITY RISK CATEGORY :- ____HIGH ____MEDIUM
Month Day Year From: Hrs To: Hrs ____LOW
Day Saturday Sunday Monday Tuesday Wednesday Thursday Friday
Date
Time of Issue
Receiver
Issuer
HSE Review
No. of Workers
Exact work location:

Work Description:
Equipment/Tools to be used:
Person in charge: (Name in Print)
CONTRACTOR: SUB-CONTRACTOR:
1．Was a joint site inspection done? Yes No If No, explain why not
2. SPECIAL PRECAUTIONS AND EQUIPMENT REQUIRED

□Equipment in good condition and inspected □Isolation required □Method statement required
□Safety watch required □Barricades around open excavation □Job Safety Analysis required
□Cold drinking water available □Breathing Apparatus □Warning lights required
□Heat shelter provided □Air Mover □Workers received safety training
□Medical aid readily available □Work Area Barricaded Posted with warning signs □Adequate lighting
□Emergency vehicle on site □Fire Extinguisher □Toolbox talk required
□Flagman/Spotter in place □Full body harness w/lanyard □Danger from Gas under pressure
□Gas Test required □Hand Gloves □Scaffolding required
□Radio Communication □Face shield □Work after daylight
□Harness and hand line □Standard PPE(safety hardhats, boots, safety glasses) □Danger from radioactive materials
□Overhead clearance established □Standby-Man □Additional permit required
□Sumps covered □Marked Plot Plan provided □Type& no. of permit:
□Company CM or Contractor CM confirmation □Others:(Explain in 3 below)
required
3. List any additional precautions :
4. Record the gas test result in the following table if in confined space or Potential Hazardous Atmosphere is expected.
ONLY CERTIFIED GAS TESTERS PERFORM GAS TESTS
CONDUCT GAS TEST Values Gas Tester’s
EVERY HRS Flammables(% of H2S (PPM) O2 (%) Other Gases Badge No. Signature
INTERVAL LEL)
5. PERMIT APPROVAL
PERMIT OPEN NAME(Print) BADGE NO.（iqama ） CERT NO. SIGNATURE
RECEIVER(SUB-CONTRACTOR)
ISSUER(CONTRACTOR)
HSE Review
6. EXTENDED HOURS AUTHORIZATION
Day Saturday Sunday Monday Tuesday Wednesday Thursday Friday
Time of Issue
Issuer
Receiver
HSE Review
7. PERMIT CLOSURE
I HAVE INSPECTED THE WORK SITE AND CONFIRM THAT IT HAS BEEN RETURNED TO OPERATING CONDITION.
Receiver Name Date & Time Issuer Name Signature Date & Time
Closed Signature
8. Complete – As necessary: Company CM Countersignature or Contractor CM Countersignature

______________
Note: This Permit is void if not used within two (2) hours from the time of issue.
9. In case of emergency ________________________________________________________________________________

_________________________________________________________________________________________________________________________
Accelerated Carbon Capture and Sequestration (ACCS) PROJECT
Contract No: 6601019393
Issue Date:
HAZARD ANALYSIS CHECKLIST
Any ‘N’ (NO) answers below shall initiate a “STOP” point where the Issuer and Receiver Issuer/Receiver pre
are to analyse the hazard(s) and develop methods to adequately control the hazard(s) Doc:
walkthrough checklist
and list the additional precautions on the permit.
Page 1 of 1
Date: - To Permit NO: Legends: Y, N, N/A
1. Is the correct type of permit(s) issued for the work?
2. Have the Job Safety Analysis (JSA) and other applicable supplementary
forms been communicated to the work crew?
3. Are weather conditions (e.g., wind speed, rain, fog, heat, lightning)
acceptable to perform the work?
4. Are slip and trip hazards controlled?
5. Does the work crew have the correct tools/ equipment for the job? Are they in
good condition?
6. Do personnel have the proper certifications to perform the activity and/or
operate the equipment?
7. Is the equipment’s inspection sticker valid?
8. Have all requirements for working at heights (i.e., fall protection) been
applied?
9. Is the scaffold tag completed correctly, signed, and with a valid inspection
date?
10. Has the potential for contact with sharp objects, rotating equipment, hot/cold
surfaces, or live electricity been eliminated?
11. Is the system/equipment properly isolated and locked out? Did all workers
apply their personal locks?
12. Has the system/equipment been depressurized, drained, and/or purged
before opening it?
13. Has the potential for releasing flammable liquids and gases been controlled?
14. Are all ignition sources eliminated or controlled?

15. Does the fire watch have firefighting equipment readily available and know
how to use the equipment?
16. Has the potential for exposure to high noise levels, H2S, hydrocarbons,
asbestos, hazardous chemicals, or radioactive materials been controlled?
17. Is the correct personal protective equipment (PPE) available for use by
personnel?
18. If the work may impact others nearby, or vice versa, have the work crews
discussed their activities with each other (i.e., simultaneous operations
[SIMOPS])?
19. Is there an emergency contingency plan in place to respond to the work being
performed?
20. Does the work crew know what to do in the event of an emergency, such as
evacuation routes, location of emergency equipment, and where assembly
areas are located?
Permit Issuer Signature
WPR Signatures
Date

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Accelerated Carbon Capture and Sequestration (ACCS) PROJECT

Daily Validation of Hot Work Permit

HOT WORK PERMIT NO. HWP-

Exact work location:

2. SPECIAL PRECAUTIONS AND EQUIPMENT REQUIRED

3. List any additional precautions :

8. Complete – As necessary: Company CM Countersignature or Contractor CM Countersignature

9. In case of emergency ________________________________________________________________________________

14. Are all ignition sources eliminated or controlled?

Permit Issuer Signature

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