Fleet Management Limited

ON BOARD COLD WORK PERMIT

This permit relates to any work in a hazardous or dangerous area which will not involve generation of temperature conditions
likely to be of sufficient intensity to cause ignition of combustible gases, vapours or liquids in or adjacent to the area involved.

MV/MT ______________________________________ Master ________________________________________

Date ______________________________________ Chief Engineer __________________________________
Sea/Port/Anchor ______________________________ Chief Officer ____________________________________
Cargo/Ballast _________________________________ Type of cargo ___________________________________
Reason for work_____________________________________________________________________________
Location of work _____________________________________________________________________________
Description of work ___________________________________________________________________________
This permit is valid : From ___________hrs Date____________ To ___________hrs Date_______________
( Validity of this permit should not exceed 12 hours)
Has an enclosed space entry permit been issued?
YES / NO
Reason if 'NO': _____________________________________________________________________________
Personnel carrying out cold work ______________________________________________________________
Personnel responsible for cold work ____________________________________________________________
If vessel is in port, has written approval been obtained from port authorities, where necessary? YES / NO

SECTION 1
Preparation and checks to be carried out by Officer in Charge of cold work to be performed.
Yes
1 The equipment/pipeline has been prepared as follows :
Vented to atmosphere :
Drained :
Washed :
Purged :
2 The equipment/pipeline has been isolated as follows :
Lines Blanked :
Lines Disconnected :
Valves Closed :
Other : _______________________________________
3 Is equipment free from :
Oil :
Gas :
H2S :
Steam :
Pressure :

No

N/A

4 Is surrounding area free from hazards ?

5 If work is to be performed on electrical equipment has EIC Permit (Form DE-23D)
been filled ?

SECTION 2
Information and instructions to person carrying out cold work :
1 The following personal protection must be worn __________________________________________________
2 Equipment/pipeline contained following material in service _________________________________________
3 Equipment expected to contain the following hazardous material when opened _________________________
4 Special conditions / precautions ______________________________________________________________
In the circumstances noted it is considered safe to proceed with this cold work.
Signed : Master _______________________

SECTION 3

Person carrying out work task ______________________

or in charge of cold work team

Cold work has been completed & all persons under my supervision, materials and equipment have been withdrawn.

Person in charge of cold work team_________________Time ____________

Date ___________

THIS PERMIT IS RENDERED INVALID SHOULD ANY OF THE CONDITIONS NOTED IN THE CHECKLIST CHANGE
Note : This permit should be used for but not be limited to the following cold work:
A.OPENING UP FUEL OIL / DIESEL OIL / LUB OIL PIPELINES, VALVES AND FLANGES IN THE ENGINE ROOM
B.OPENING UP OF ANY PIPELINES, VALVES, FLANGES OR PUMPS IN HAZARDOUS AND DANGEROUS AREAS
SUCH AS PUMPROOMS, CARGO TANKS AND VOID SPACES
REV 2

Original : Master Pink Copy: Fleet Management Limited Yellow Copy: For display at Work area

Dec-05

DE-23C