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F03e Working Permit 1 2

- Hot Work -

HOT WORK Work on PIPELINES OR PRESSURE VESSELS

Relating to any work involving temperature conditions which are likely to be of sufficient intensity to cause ignition of combustible gases,
vapour or liquids in or adjacent to the area involved.

General

Vessel: CMA CGM PARSIFAL Location of Work: Aux Blr area

Description of work: Cutting and electric-arc welding

This permit is valid from: 05/01/15 08:30 to: 05/01/15 17:00

(Date) (Time) (Date) (Time)

Person in charge of work team:

(Name / Rank)

Person(s) carrying out the work:

(Name / Rank) (Name / Rank)

(Name / Rank) (Name / Rank)

Section 1 Pre-work checks

(to be checked jointly by the Master or the responsible Officer / Engineer and the persons carrying out the work)
Yes No

Has the Toolbox Talk Meeting been held?* (incl. the discussion of the Risk Assessment for the work)
Is an enclosed space Entry Permit (ERS-Form F03a) required?
Have work area and adjacent areas been checked for danger of combustible gas / materials?
Is the equipment or pipeline free of gas?
Has the equipment or pipeline been purged?
Has the equipment or pipeline been blanked?
Is the equipment or pipeline free of liquid?
Is the area safe and good ventilated for hot work?
Is additional fire protection available (e.g. Fire Extinguisher, Fire Hose delete not applicable item)
A fire watch has been instructed and set up in adjacent compartments and areas?
Person(s) doing fire watch:
(Name / Rank) (Name / Rank)

Is the equipment electrically isolated?

Special conditions or precautions required? Details if Yes:
The following Personal Protection Equipment (PPE) must be worn:
Helmet Working Clothes (Overall) Leather gauntlets / apron

Working Gloves Goggles Visor

Equipment / pipeline contains following material / substance when in service:

Equipment / pipeline is expected to contain the following hazardous material(s) / substance(s) when opened:

Signed upon completion of Section 1 by:

Master or responsible Officer / Engineer:
(Date / Time) (Name / Rank) (Signature)

(Date / Time) (Name / Rank) (Signature)

Person(s) carrying out the work

or person in charge of work team: (Date / Time) (Name / Rank) (Signature)

(Date / Time) (Name / Rank) (Signature)

ERS-Form F03e Release: 22 | 01.12.2013 Filing Instruction: Folder D03

* Please add the related ERS-Form F02c Toolbox Talk Meeting
 Page of:
F03e Working Permit 2 2
- Hot Work -

Section 2 Completion of job

(to be completed and signed by the responsible Officer / Engineer )

The work has been completed and all persons under my supervision, material and equipment have been
withdrawn:

Job completed:
(Date / Time) (Name / Rank) (Signature)

Space secured against entry:

(Date / Time) (Name / Rank) (Signature)

Officer / Engineer of the watch informed:

(Date / Time) (Name / Rank) (Signature)

Fire watch completed:

(Date / Time) (Name / Rank) (Signature)

hours after completion of work

This permit is rendered invalid should any of the conditions noted in the checklist change.

ERS-Form F03e Release: 22 | 01.12.2013 Filing Instruction: Folder D03

* Please add the related ERS-Form F02c Toolbox Talk Meeting