Grangemouth Site

Application to Perform Work

Project/Job Title

Form AP -1

Print Company Name

Contact Telephone Number

(A) The Job Engineer or Contractor carrying out the work will:
1. Use this document when applying for a new Permit or to change an existing Permit task definition.
2. Notify the BP person responsible for planning Permit work at least 24 hours prior to work commencing.
3. Provide accurate detailed information to enable work to be clearly defined and risk assessed.
Supply any other relevant support documentation required to ensure safe execution of work.
(Note: Any deviation from task definition provided will invalidate the risk assessment and Permit to Work)
(B) The BP person responsible for planning Permit to Work activities will:
1. Ensure all relevant information provided (section C) is accurately communicated to persons carrying out
task risk assessment and permit issue work.
(C)

Description of work to be carried out (circle relevant description boxes as required)

Plant Name
First Permit for New Job/Task
Existing Task Definition Change

Yes
Yes

Area/Location(s)
No
No
Permit No

Below Ground
Excavation
Drainage
Vessels
Ground Level
Plant Equipment
Pipe work
Cables
Above Ground
Plant Equipment
Pipe work
Cables
Type of tools
Hand
Power Driven
Battery
Hot type Work
Grinding
Welding
Cutting
Electrical/Instrument Testing
Yes
No
Radiography
Yes
No
Confined Space Entry
Yes
No
Mobile Plant (Drive)
Diesel
Pneumatic
Electric
Mobile Plant (Describe)
Use of Temporary Hoses
Yes
No
Movement of Heavy Equipment
Yes
No
Access Closure
Roadways
Pathway
Railway
Attached Documents
Further Description of Work
Yes
No
Approved Method Statement
Yes
No
Drawings/Other Information
Yes
No
COSHH Assessment
Yes
No
Assessment

Pipe work
Structure
Structure
Electric
Flame

Cables
Buildings
Buildings
Diesel
Sparking

Pile Driving
Roadways
Pneumatic
Heat

No

Comments

Date Permit Required

Position
(A) Job Engineer or Contractor
Print Name
Signature
Date

(B) BP Person Planning Permit Work