Commissioning Area Work Permit COMMISSIONING HAZARDS IDENTIFICATIONS

(For Construction Works)

DESCRIPTION OF THE WORKS : PTW No° : ELECTRICAL HAZARDS MECHANICAL HAZRARDS THERMAL HAZARDS
OTHER PERMIT REQUESTED ENERGIZED SYSTEM TRANSITIONAL MECHANICS OR EQUIPMENT
HOT WORK COLD WORK DE-ENERGIZED SYSTEM TROTATIONAL CHEMICALS OR EXPLOSION
AREA CONCERNED WORKS PRESSURE TEST OTHERS
UNIT SYST CODE DESIGNATION TYPE OF OPERATION PRESSURE HAZARDS OTHER HAZARDS (PLEASE SPECIFY)
5 HFE2 BO-H- PAF remain works LR : LOCK-OUT REGIME HYDROSTATIC DANGEROUS FUMES GENERATED
EXPECTED WORK DATE ESTIMATED COMPANY / TR : TEST REGIME PNEUMATIC RADIOACTIVES OR MICROWAVES
AREA LEVEL
DD MM YY HH DURATION DEPARTMENT AWR : AGREEMENT WITHOUT REGIM N2 PURGING OR DE-PURGING
PAF area +1600 15 08 2013 07:00 5 MECH / Buzzichelli SR : SPECIAL REGIME FLUSHING - OIL, CHEMECAL, ETC
Whatever the certificate that has been issued, all responsibles for their DOCUMENTS ATTACHED
intervention may be undertaken only after verifying the key points and the
JSA M/S OTHERS
security measures taken its obligations. GENERAL TIPS FOR SAFE WORK IN COMMISSIONING AREA
Y N Y N Y N
KKS ISNSTRUCTIONS LOCATIONS STATUS SECTION FOR PERMIT APPROVAL
50HFE60 PAF “A” side remain works PAF “A” unit 5 REQUESTED BY TASK SUPERVISOR 1. BE SURE ABOUT KNOWING ALL PARTICIPANTS ARE AWARE OF ANY POSSIBLE THREATS OF ENERGY
AN001 - Shaft & Coupling re-adjustment DD MM YY SIGNATURE 2. BE SURE ABOUT WHAT YOU ARE ABOUT TO DO, WHAT OTHERS ARE DOING AND WHAT WILL BE DONE.
DATE
3. DON'T BE AFRAID TO ASK DUMB QUESTIONS IF YOU ARE NOT FULLY AWARE OF ALL RISKS.
NAME 4. ALWAYS CONSIDER ELECTRICAL EQUIPMENT TO BE LIVE UNTIL IT IS FULLY ISOLATED AND TESTED TO
REVIEWED BY MD CONST. RESPONSIBLE 5. HANDLING & USE OF CHEMICALS IN COMMISSIONING AREA SHOULDE BE CONTROLLED BY COMPETE
DD MM YY SIGNATURE 6. WHEN RETURN TO WORK FROM A BREAK, ASSUME THAT THINGS HAVE CHANGED AND RECHECK LIV
DATE
7. SMOKING IS STRICKTLY PROHIBITED DURING WORKING IN COMMSSIONING AND/OR OPERATION AREA
NAME 8. NEVER WORK ALONE WHEN WORKING AT COMMISSIONING AREA.
REVIEWED BY KPS PTW COORDINATOR 9. TEST BEFORE YOU TOUCH, EVEN IF YOU HAVE JUST ISOLATED EQUIPMENT.
DD MM YY SIGNATURE 10.TRUST TEST EQUIPMENT OR SENSOR TO VERIFY DANGEROUSE POTENTIAL THAN YOUR PERSONAL B
DATE
KNOWLEDGE OR EXPERIENCE OR ATTACHED LABEL TO IDENTIFY A DEAD (NOT ENERGIZED) EQUIPME
NAME
REVIEWED BY KPS OPERATION MANAGER
GENERAL PREPARATIONS FOR APPLYING WORKS IN COMMISSIONING AREA
DD MM YY SIGNATURE
DATE

NAME TICK (✓) THE BOX BELOW. THE KPS PTW COORDINATOR OR OPERATION MANAGER MUST CHECK AND SPECIFY BELOW.

REVIEWED BY MD PTW COORDINATOR Y N NA TYPES OF LOTO WHICH WILL BE APPLIE Y N POTENTIONAL HAZARDS DUE TO CONST. WOR
DD MM YY SIGNATURE ENERGY SOURCES LOCKED AND TAGGE GENERATION OF FIRE OR EXPLOSION HAZAR
DATE
LOCAL ELECTRICAL CIRCUIT ISOLATED GENERATION OF FALLING OBJECTS
NAME PIPING OR EQUIPMENT ISOLATED USE OF HAZARDOUS SUBSTANCES TO HEALT
APPROVED BY MD COMM. MANAGER RESIDUAL ENERGY DISCHARGED ANY ERECTION OF MATERIAL (E.G. SCAFFOLD
DD MM YY SIGNATURE DRAINS SEALED, COVERED OR PLUUGE OTHERS
DATE

NAME
PERSONAL PROTECTIVE EQUIPMENT & TOOLS REQUESTED
PRE-INSPECTION COMMENTS BY COMMISSIONING SAFETY TEAM SECTION FOR PERMIT CLOSURE
COMPLETED BY TSAK SUPERVISOR
DD MM YY SIGNATURE BASIC PPE - HELMET, GOOGLE, GLOVES, SHO SPECIFY TOOLS REQUESTED - GAS DETECTOR, E
DATE
SPECIFIC PPE
NAME HEARING PROTECTION BODY PROTECTION
EXTENSION APPROVED BY CHECKED BY KPS PTW COORDNIATOR FALL PROTECTION RESPIRATORY PROTECTION
DD MM YY HH AREA RESPONSIBLE SIGNATURE DD MM YY SIGNATURE EYE & FACE PROTECTION OTHERS
DATE DATE

COMMENTS NAME
EMERGENCY CONTACT INFORMATION
SUSPENSION ISSUED BY CLOSED BY KPS OPERATION MGR
DD MM YY HH AREA RESPONSIBLE SIGNATURE DD MM YY SIGNATURE EMERGENCY CONTACT NUMBER OF COMPANY TASK SUPERVISOR : ( )
DATE DATE
IN CASE OF ANY EMERGENCY AT WORK, IMMDEDIATELY CONTACT BELOW NUMBERS.
COMMENTS NAME - AMBULANCE : 06.51.35.17.46 - KPS HSE : 06.67.14.34.49 - MD HSSE : 06.62.64.46.82
OP : OPENED LOK : LOCKED LCL : LOCKED IN CLOSED POSITION LOP : LOCKED IN OPEN POSITION ANY WORKS IN COMMISSIONING AREA MUST BE APPROVED BY KPS OPERATION MGR & MD COMMISSIONING MGR.
CL : CLOSED LKR : LOCKED KEY RELEASED LWD : LOCKED IN WITHDRAWN POSITIAV : AVAILABLE FOR OPERATION FAILURE OF ABOVE WILL BE RESULTED IN IMMEDIATE SUSPENTION OF THE WORKS AND DESCIPLINARY ACTIONS.
 Commissioning Test Work Permit COMMISSIONING HAZARDS IDENTIFICATIONS
(Only For MD & KPS)
DESCRIPTION OF THE TESTS : PTW No° : ELECTRICAL HAZARDS MECHANICAL HAZRARDS THERMAL HAZARDS
ANY CONS. WORKS IN THE AREA ENERGIZED SYSTEM TRANSITIONAL MECHANICS OR EQUIPMENT
HOT WORK COLD WORK DE-ENERGIZED SYSTEM ROTATIONAL CHEMICALS OR EXPLOSION
AREA CONCERNED WORKS PRESSURE TEST OTHERS
UNIT SYST CODE DESIGNATION TYPE OF OPERATION PRESSURE HAZARDS OTHER HAZARDS (PLEASE SPECIFY)
LR : LOCK-OUT REGIME HYDROSTATIC DANGEROUS FUMES GENERATED
EXPECTED TEST DATE ESTIMATED COMPANY / TR : TEST REGIME PNEUMATIC RADIOACTIVES OR MICROWAVES
AREA LEVEL
DD MM YY HH DURATION DEPARTMENT AWR : AGREEMENT WITHOUT REGIM N2 PURGING OR DE-PURGING
SR : SPECIAL REGIME FLUSHING - OIL, CHEMECAL, ETC
Whatever the certificate that has been issued, all responsibles for their DOCUMENTS ATTACHED
intervention may be undertaken only after verifying the key points and the
JSA M/S OTHERS
security measures taken its obligations. GENERAL INFORMATION ON THE COMMISSIONING TEST
Y N Y N Y N
KKS ISNSTRUCTIONS LOCATIONS STATUS SECTION FOR PERMIT APPROVAL
REQUESTED BY KPS TASK SUPERVISOR TYPES OF TEST TYPE OF SYSTEM TYPES OF LOTO APPLIED
DD MM YY SIGNATURE ENERGIZATION ELECTRICAL ENERGY SOURCES LOCKED & TAGG
DATE
FUNCTION TEST INSTRUMENT OR TELECOM LOCAL ELECTRICAL CIRCUIT ISOLAT
NAME SOLO TEST MECHANICAL PIPING OR EQUIPMENT ISOLATED
REVIEWED BY KPS SECTION MANAGER NO-LOAD TEST PIPING RESIDUAL ENERGY DISCHARGED
DD MM YY SIGNATURE LOAD TEST HVAC SYSTEM EQUIPMENT DECONTAMINATED
DATE
OTHERS OTHERS DRAINS SEALED, COVERED OR PLUGGED
NAME
REVIEWED BY MD COMM. RESPONSIBLE
SAFETY CHECKLIST BEFORE TEST (INSPECTED BY: NAME SIGNATURE)
DD MM YY SIGNATURE
DATE

NAME Y N NA TICK (✓) THE APPROPIATE BOX BELOW REMARKS SHOULD BE DONE BEFORE THE TE
REVIEWED BY KPS OPERATION MANAGER AREA IN GOOD CONDITION - PLATFORM, ACCESS, E
DD MM YY SIGNATURE TOOLS & EQUIPMENT ARE INSPECTED & FREE OF DEMAGES?
DATE
PTW SIGNED & FILLED UP WITH PROPER JSA, RA O
NAME PROPER HOUSEKEEPING DONE BEFORE TEST?
REVIEWED BY MD PTW COORDINATOR SIGNS & BARRICADES POSTED?
DD MM YY SIGNATURE REQUIRED FIRE EQUIPMENT PROVIDED?
DATE
ADJACENT ACTIVITIES NOTIFIED & STOPPED? (IF R
NAME SUITABLE & SUFFICIENT PPE WORN?
APPROVED BY MD COMM. MANAGER NO "A" CLASS RESERVATIONS REMAINED?
DD MM YY SIGNATURE OTHERS
DATE

NAME
PERSONAL PROTECTIVE EQUIPMENT & TOOLS REQUESTED
PRE-INSPECTION COMMENTS BY COMMISSIONING SAFETY TEAM SECTION FOR PERMIT CLOSURE
COMPLETED BY TSAK SUPERVISOR
DD MM YY SIGNATURE BASIC PPE - HELMET, GOOGLE, GLOVES, SHOES SPECIFY TOOLS REQUESTED - GAS DETECTOR, ETC.
DATE
SPECIFIC PPE
NAME HEARING PROTECTION BODY PROTECTION
EXTENSION APPROVED BY CHECKED BY KPS PTW COORDNIATOR FALL PROTECTION RESPIRATORY PROTECTION
DD MM YY HH AREA RESPONSIBLE SIGNATURE DD MM YY SIGNATURE EYE & FACE PROTECTION OTHERS
DATE DATE

COMMENTS NAME
EMERGENCY CONTACT INFORMATION
SUSPENSION ISSUED BY CLOSED BY KPS OPERATION MGR
DD MM YY HH AREA RESPONSIBLE SIGNATURE DD MM YY SIGNATURE EMERGENCY CONTACT NUMBER OF KPS TASK SUPERVISOR : ( )
DATE DATE
IN CASE OF ANY EMERGENCY AT WORK, IMMDEDIATELY CONTACT BELOW NUMBERS.
COMMENTS NAME - AMBULANCE : 06.51.35.17.46 - KPS HSE : 06.67.14.34.49 - MD HSSE : 06.62.64.46.82
OP : OPENED LOK : LOCKED LCL : LOCKED IN CLOSED POSITION LOP : LOCKED IN OPEN POSITION ANY COMMISSIONING TEST MUST BE INSPECTED BY HSE TEAM AND APPROVED BY MD COMMISSIONING MANAGER.
CL : CLOSED LKR : LOCKED KEY RELEASED LWD : LOCKED IN WITHDRAWN POSITIAV : AVAILABLE FOR OPERATION FAILURE OF ABOVE WILL BE RESULTED IN IMMEDIATE SUSPENTION OF THE TEST AND DESCIPLINARY ACTIONS.