INDIAN OIL SAFETY MANAGEMENT SYSTEM [ SURAKSHA

]

WORK PERMIT SYSTEM

ISMS STANDARD - 1006
First Edition, November’ 2007

INDIAN OIL CORPORATION LIMITED
REFINERIES HEAD OFFICE SCOPE COMPLEX, CORE – 2, 7, INSTITUTIONAL AREA, LODHI ROAD,

NEW DELHI – 110 003

ISMS Standard-1006

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ISMS STANDARD - 1006
First Edition, November 2007

WORK PERMIT SYSTEM
IMPORTANT

Mandatory requirements (or "must") are characterised by the word "SHALL" throughout the text. Advisory requirements or recommendations are indicated by the word "SHOULD."

Prepared by :

COMMITTEE ON STANDARDISATION OF SAFETY SYSTEMS

INDIAN OIL CORPORATION LIMITED
REFINERIES HEAD OFFICE SCOPE COMPLEX, CORE – 2, 7, INSTITUTIONAL AREA, LODHI ROAD,

NEW DELHI – 110 003

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NOTES
This document is prepared for use in the Indian Oil Corporation Limited, Refineries Division. This is the property of Indian Oil Corporation Limited, Refineries Division and shall not be reproduced or copied and loaned or exhibited to others without written consent from Executive Director (Operation), IOCL, Refineries Division, New Delhi. Though every effort has been made to assure the accuracy and reliability of data contained in this document, Committee hereby disclaims any liability or responsibility for loss / damage resulting from its use. This document is intended only to supplement and not replace the prevailing statutory requirements.

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PREFACE
Over the years of operation, Refineries under the umbrella of Indian Oil Corporation Limited [i.e. IOCL], adopted variety of safety practices in line with the requirements of statutes, national and international norms & Standards and safety management system in safety practices. Based on safety assessment studies and some serious accidents that occurred in the recent past in IOCL Refineries, emphasized the need for the review of existing safety practices of IOCL Refineries. With this in view, it has been decided at IOCL (RD), Head Office (H.O.) to standardize the key Safety Management System elements for the Refineries Division exploiting internal knowledge bank and resources. In accordance with this decision, a committee has been constituted by Executive Director (Operation), IOCL, H.O., for the said purpose under his convenership. The present document on “Work Permit System”, prepared by the Committee on Standardisation of “Work Permit System”, is based on the various national and international codes, OISD Std., best practices prevailing in the IOCL Refineries and accumulated knowledge & experience of the members. Provisions of this standard if implemented objectively will help in improving safety standards at work places and thereby reducing the possibility of undesired incidents in IOCL, Refineries. No change in the standard is permitted at unit level. Suggestions for amendments / changes, if any, to this standard shall be addressed to: The Executive Director (Operation), Indian Oil Corporation Limited
Refineries Head Office Scope Complex, Core – 2, 7, Institutional Area, Lodhi Road,

New Delhi – 110 003

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COMMITTEE ON WORK PERMIT SYSTEM
LIST OF MEMBERS

Sl. No. 1. 2. 3. 4. 5.

Name Shri N. K. Bansal Shri S. K. Das Shri A. Chaudhuri Shri D. Chakraborty Shri Sunil Kumar

Designation ED (O) CM (QA & Systems) CPNM CTSM CM (F&S)

Location R&P, H.O. Mathura Refinery Haldia Refinery Barauni Refinery Gujarat Refinery

Position in Committee Convener Member Member Member Member

The committee expresses sincere gratitude to Shri A. Panda, GM (S&EP), H.O., New Delhi for his immense support and guidance in formulating this standard. The committee also extends sincere thanks to Shri G. B. Tolmare, CM (SHE), C.O., New Delhi for his contribution, involvement and sharing of knowledge & experience which has helped in framing the standard.

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CONTENTS
Section 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Annexures 1. 1A. 2. 2A. 2B 2C 2D 2E 3 3A 3B 3C 3D 4 5. 6. 6A. 7. 7A. 8. 8A 8B 8C 9 Format for “Cold Work Permit” Dos and Don’t for Cold Work Format for “Hot Work/Entry Into Confined Space Permit Dos and Don’t for Hot Work Dos and Don’ts for Entry intro Confined Space Format for Pre Entry Checklist for Confined Space Format of “Attendance Sheet” Format for “Confined Space Box-up Clearance” Format for “Excavation Permit” Dos and Don’ts During Excavation Work Format for “Excavation Permit” Format for “Road Closure” Format for “Information about main road closure” Format for “Electrical Isolation/Energisation Permit-HT Format for Electrical Isolation/Energisation Permit-LT Format for “Permit to Work on HT Line/Equipment” Format for “Trip Reset of HT Equipment” Format for “Permit to Work on LT Line/Equipment” Format for “Trip Reset of LT Equipment” Format for “Working At Height” Format for “Pre Erection Checklist for Scaffold” Format for “Scaffold Check” Format for “Medical Certificate” Format for “Radiation Permit” 34 38 39 45 46 47 49 50 52 54 55 57 58 59 61 63 65 67 69 71 74 75 76 78 Attribute Purpose Scope Definitions & Abbreviations Introduction Works, Require Permit Work Do Not Require Permit Type of Work Permits, Clearances & Formats General Requirements of work Permit Responsibilities of Permit Signatories Work Permit Procedure / Guidelines Training and Awarness Review Audit of Work Permit System References Page No. 6 6 6 7 8 8 9 11 13 15 32 32 32 33

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Work Permit System
1 PURPOSE The purpose of this standard is to describe procedures and guidelines on work permit system to carry out jobs of inspection, testing, maintenance, alternation, repair, upkeepment and construction in safest possible manner. The implementation of this system will help in bring down the risks at work sites to acceptable level, thereby reducing possibility of any accident, fire, explosion, property damage and adverse effect on environment. 2. SCOPE This standard shall be applicable to all the Refinery premises of Indian Oil Corporation Limited. 3. a) DEFINITIONS AND ABBREVIATIONS Hot Work: An activity that can produce a spark or flame or other source of ignition having sufficient energy to cause ignition, where the potential for flammable vapors, gases, or dust exists. This includes all works, which produces spark, running of IC engine, breaking of concrete, use of ordinary torches, use of battery operated devices etc. Cold Work: Cold Work is an activity that does not produce sufficient heat to ignite a flammable air- hydrocarbon mixture or a flammable substance. Radiation Work: Any activity that is carried with a source of ionizing radiation, which does not produce sufficient heat to ignite a flammable air- hydrocarbon mixture or a flammable substance. Working at Height: Any activity that is carried out at 2.0 meters & above on temporary structure, scaffolds or on a structure not meant to do particular job safely. Excavation: Any job, which requires excavation / digging of earth. An Excavation is any man-made cut, cavity, trench, or depression in an earth surface that is formed by earth removal. A Trench is a narrow excavation (in relation to its length) made below the surface of the ground. In general, the depth of a trench is greater than its width, and the width (measured at the bottom) is not greater than 15 ft (4.6 m). If a form or other structure installed or constructed in an excavation reduces the distance between the form and the side of the excavation to 15 ft (4.6 m) or less (measured at the bottom of the excavation), the excavation is also considered to be a trench. f) Confined Space: It is an enclosure with known potential hazards and restricted means of entrance and exit. It is not meant for normal occupancy of people and is usually not well ventilated such as vessels, boilers, storage tanks, large diameter piping etc. The excavation more than 1.2 M deep, entry into floating roof tanks, when roof is more than

b)

c)

d)

e)

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3M down from the top, space located below ground level such as pits, drain channels etc shall also be considered as confined space. g) Lower Explosive Limit (LEL): LEL is the minimum concentration of a vapour in air (or other oxidant) below which propagation of flame does not occur on contact with an ignition source. This is usually expressed as volume percentage of the vapor in air. Upper Explosive Limit (UEL): UEL is the maximum concentration of a vapor in air (or other oxidant) above which propagation of flame does not occur on contact with and ignition source. This is usually expressed as a volume percentage of vapors in air. Pyrophoric Substance : Substances that ignites spontaneously in air at ambient temperature. In hydrocarbon industries iron sulphide is the most commonly observed pyrophoric substance and is called as pyrophoric iron. Self Contained Breathing Apparatus (SCBA): It is an life saving personal protective apparatus consisting of a face mask, combined with a hose and source of fresh air generally in form of a cylinder of compressed air, to be carried by bearer. Gas Safety Inspector (GSI)/Issuer: GSI means a designated officer authorized to perform all necessary tests before signing a work permit. He must satisfy himself by a personal inspection that the tank / vessel /line /equipment/ any other confined space involved is safe for the work intended. He can independently issue Cold work permit and permit for working at height. Fire Permit Signatory (FPS)/Issuer: FPS means a designated officer authorized to issue work permit. He is ‘Fire Permit Signatory’/‘Issuer’ in case of Hot work/ Vessel entry/ Excavation permit and for any other permit. He issues the permit for the particular job after addressing the checklist points of permit for the units/ areas, where he is the incharge. FPS will sign the permit after getting satisfied that GSI has carried out all the tests/checks and signed the permit. Receiver (Permittee) : The ‘Receiver’ the designated person authorized to receive work permit. Receiver generally is the executing department officer, who has to execute the particular job for which permit has been issued. The executing officer can be Engineer In-charge / Site in-charge of the job or any other nominated officer for executing dept. (normally service dept). Blanket permit: The hot work permit issued to areas after due consideration to safety (the fire hazard is minimum and hazards due to adjoining facilities taken into consideration) with approval of local management for a maximum period of 1 month. Such permit shall not need shift-wise renewal, however the executer has to ensure that permit conditions are complied throughout the work period. INTRODUCTION The human element of the system has one of the biggest potentials for either causing or preventing an accident. Safe job performance by operating, maintenance personnel and contractors has a tremendous positive impact on safety. ISMS Standard-1006 Page 8 of 34

h)

i)

ij

k)

l)

m)

n)

4.

The objectives of the Work Permit System are to exercise control over the maintenance, repair and construction activities by assigning responsibilities, ensuring clear cut communication between interested functions & safety considerations to the job, its hazards & the precautions required. It ensures that the work is properly defined, authorised, operating personnel are aware what is going on, precautions to be taken are specified and the persons executing the job understand the nature and extent of hazards involved. Work Permit System is an important element of safety management system and implementation of this in true spirit shall help in ensuring a safe working environment, thereby reducing possibility of injury to personnel, protect property, avoid fire, explosion & adverse affect on environment. 5. WORKS, REQUIRE PERMIT Normally all maintenance, repair, construction work shall be carried out with a proper work permit. Jobs where work permit is required include but not limited to followings: • • • • • • • • • • • • • • 6. Major and minor maintenance work Inspection Construction Alteration Any hot work (including use of normal battery driven equipment in operating areas) Cleaning activities of process equipment Entry into confined space Excavation Vehicle entry into process areas Work at height Handling of materials using mechanized means in operating areas Erection and dismantling of scaffold Radiography Isolation and energisation of electric equipment/ facilities

WORKS EXEMPTED/ PARTIALLY EXEMPTED FROM REQUIREMENT OF PERMIT • Routine work carried out by operations Dept. personnel (e.g. pump change over, furnace lighting, operating valves etc.). It is considered that safety measures are built-in in system while carrying out above works and covered in Operating manuals. Routine work carried out on equipment taken into workshop by maintenance dept. and routine operation of workshop equipment (except hot work permit). Routine testing of samples and handling chemicals in Quality Control Laboratory (except hot work permit).

• •

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• •

Jobs carried out during emergencies (fire/ explosion, rescue, uncontrolled release of hazardous chemicals etc.) to control the emergency. Work carried out at construction site with management approval (except permit for hot work, radiography and working at height)

7.

TYPE OF WORK PERMITS, CLEARANCES AND FORMATS Depending on the nature of the job, there are 7 types of work permit formats covering various works as mentioned below:

7.1

Cold Work Permit This permit is required for carrying out any activity of maintenance/ cleaning / testing inside refinery that does not produce sufficient heat to ignite a flammable airhydrocarbon mixture or a flammable substance. The format for “Cold Work Permit” is enclosed as Annexure-1. “Dos and Don’ts for Cold Work Permit” duly signed shall be attached with each permit. The same is enclosed as Annexure-1A. The list of job includes blinding, de-blinding of equipment/ facilities, tightening/ loosening of bolts, insulation, painting of lines, cleaning of equipment, repairing on instruments on facilities etc.

7.2

Hot work / Entry In To Confined Space Permit and clearances Hot Work Permit is required for carrying out any activity, which produces sufficient heat to cause fire in a inflammable air- vapour mixture. Entry to Confined Space Permit is required for entry into any confined space. The Format for “Hot work / Entry To Confined Space Permit” is enclosed as Annexure-2. Duly signed “Dos and Don’ts for Hot Work Permit” shall be attached with each Hot Work Permit. The same is enclosed as Annexure-2A. Similarly duly signed “Dos and Don’ts for Confined Space Entry ” shall be attached with each Permit for Confined Space Entry. The same is enclosed as Annexure-2B. Before Issuing Permit for “Entry into Confined Space”, the requirement of “Pre Entry checklist for Confined Space” format shall be complied. The format for same is enclosed as Annexure-2C. The attendance of each entrant of confined space shall be taken by attendant at man way of equipment. The format for same is enclosed as Annexure-2D. Each confined space, where entry has been made is required to be box-up after obtaining necessary clearance. The format for “Confined Space Box-up Clearance” is enclosed as Annexure-2E.

7.3

Excavation Permit and Clearances Excavation permit is required for carrying out any excavation inside Refinery. The format for “Excavation Permit” is enclosed as Annexure-3.

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Duly signed “Dos and Don’ts during Excavation Work” shall be attached with each Excavation Permit. The same is enclosed as Annexure-3A. Duly filled signed and registered “Excavation Clearance” is prerequisite for any Excavation Permit. The format for the same is enclosed as Annexure-3B. Wherever temporary closure of road / cutting of road or blockage of main roads is required in a refinery. The necessary approval shall be obtained in format for “Road Closure, enclosed as Annexure-3C. The information about the closure of main road shall be circulated in format, enclosed as Annexure-3D. 7.4 “Electrical Isolation and Energisation Permit and Clearances For all electrical isolation and energisation of electrical equipments (HT) “Electrical Isolation and Energisation Permit-HT” Permit is required. The same is enclosed as Annexure-4. For all electrical isolation and energisation of electrical equipments (LT) “Electrical Isolation and Energisation Permit-LT” Permit is required. The same is enclosed as Annexure-5. To work on High Tension (HT) line and / or equipment, “Permit to work on High Tension (HT) Line /Equipment” is required. The same is enclosed as Annexure-6. To work on Low Tension (LT) line and / or equipment, “Permit to work on Low Tension (LT) Line /Equipment” is required. The same is enclosed as Annexure-7. For Trip reset of HT equipment, the clearance shall be taken on format “Trip Reset Clearance Certificate for HT Equipment”. The same is enclosed as Annexure-6A. For Trip reset of LT equipment, the clearance shall be taken on format “Trip Reset Clearance Certificate for LT Equipment”. The same is enclosed as Annexure-7A. 7.5 Working at Height Permit For all working at height (of 2M or above) a permit for “Working at Height” is required. The format for same is enclosed as Annexure-8. Before erection, when scaffold materials are kept at site of erection, “Pre Erection Checklist for Scaffold” shall be carried out in prescribed form. The same is enclosed as Annexure-8A All tubular scaffolds needs to checked and certified before being used. The format for checking and certifying is enclosed as Annexure-8B. The medical certificate for workmen, required to work at height is required. The format for same is enclosed as Annexure-8C. ISMS Standard-1006 Page 11 of 34

7.6

Radiation permit The all jobs, which generate ionizing radiation, “Radiation Permit” is required. The format for same is enclosed as Annexure-9.

8 8.1

GENERAL REQUIREMENTS OF WORK PERMIT All maintenance/ alteration/ construction jobs in the refinery shall be carried out under valid “Permit to Work” only. Normally operating personnel do not require work permit for carrying out routine work, however in exceptional cases where they are likely to be exposed to certain risks, work permit is required. The requirement of work permit in such cases is to be decided by FPS of the area/ Unit in-charge. Separate permit should be issued for each job. Multiple jobs in a single permit are prohibited, except Entry to confined space and hot work inside the confined space in particular equipment. In such cases a composite permit can be issued and permit must address all the applicable aspects for both the works. In a confined space where various agencies are required to work simultaneously, a risk identification and assessment may be carried out by a team of permit issuer and various executing agencies and the team may develop a plan for safe execution of work. The assessment will include a job safety analysis for each job separately as well as in totality. For job safety analysis please refer standard on “Job Safety Analysis”. The work plan is required to be approved by Management. In such cases a single permit for “Entry into confined space” can be obtained.

8.2

8.3

Permits and clearances shall be in printed forms, in duplicate or triplicate, depending on nature of job, serially numbered, Format Number and different colour code should be adopted for different types of permits and clearances. Duly signed “Dos and Don’ts” for related jobs shall be attached with each permit and safety guidelines mentioned shall be complied at work site. Depending on nature of jobs, type of permit required shall be decided. Working at Height Permit' shall be required for working at a height of 2.0 meters and above on a temporary structure or on a fixed structure, not meant for carrying out particular job safely. • • • • For all scaffolds, pre-erection checklist in prescribed form shall be carried out before start of erection and the safety guidelines shall be complied. Safety harness with lifelines secured with a fixed structure is a must for working at height. Provision of safety net should also be made. All scaffolds shall be checked and certified in prescribed form before use. The workmen involved in working at height should have medical certificate from a doctor. Page 12 of 34

8.4

8.5 8.6

ISMS Standard-1006

Permit for working at height jobs, the following is to be ensured: I. All tools should be carried in tool kits to avoid their falling. II. Throwing or dropping of material/ equipment from height is prohibited. III. Avoid jumping from one member to another of a structure. Use proper passageway. IV. Both hands should be free, while climbing the ladder. Bypassing the steps of ladder should be avoided. V. Avoid movements on overhead beam without proper fall protection. • For details of hazards, precautions and other safety features refer standard on “Scaffold Safety” and “Working At Height”. All excavation permit, excavation clearance is mandatory in prescribed form. Additionally for Closure of road, permission to be taken in prescribed form and information of the same shall be circulated to all concerned in prescribed format. • For Excavation Permit jobs, the following shall be ensured: A warning or protective barricade of 1 meter height with red & white band/ self-glowing caution board should be provided around excavation site. Excavated material should be piled at least one meter away from the edge of the excavation / trench or depth of the trench whichever is more. Provision of minimum two entries/exits should be made. Additionally in case of long trench for each 7.5 M and part there of, there should one ladder. Safe angle of repose or proper shoring/strutting to prevent cave-in should be provided as per relevant codes and safe operating practices. Excavation clearance shall be obtained from various dept. in prescribed format before applying for excavation permit. 8.8 For Radiation Permit jobs, the following shall be ensured: A warning or protective barricade of 1 meter height should be provided around the surrounding area, meeting the distance requirement as mentioned in permit and radiation sings & symbols to be displayed prominently by permittee. 8.9 Permit issuing authority shall satisfy that permit conditions are met before issuing permit. It is also to be ensured that permit conditions are maintained in course of execution of the job. Before issuing a permit, equipment is to be inspected to ensure that the equipment/ facility is prepared for safe execution of the assigned work, the area is cleaned and all safety precautions have been adopted. Wherever necessary, ensure that equipment is isolated, drained/ depressurized, properly purged, water flushed, gas tested (including Page 13 of 34

8.7

8.10

ISMS Standard-1006

oxygen deficiency test) through portable gas meters and readings have been recorded in the permit. 8.11 No hot work shall be permitted unless the Explosimeter shows zero. Entry into confined space, where no hot work is to be carried out, may be permitted if combustible gases are up-to 5% of lower explosive limit (LEL). Entry with an air-supplied mask may be permitted with LEL up to 20 %. The oxygen level should be at least 19.5 vol. % and the concentration of toxic gases below the threshold limit (TLV for H2S- 10 PPM, CO- 50 PPM, Cl2- 1 PPM, NH3- 25 PPM & SO2- 2 PPM). Confined Space box-up” clearance in prescribed form shall be obtained for only those spaces, where “Confined Space Entry” permit has been taken. The clearance shall be obtained in duplicate and a copy shall be returned to issuer on completion of work. For all “Electrical isolation and energisation of equipment / line-HT” or “Electrical isolation and energisation of equipment / line-LT” permit (Inter Dept.) shall be taken, depending on the case. Similarly “Permit to work on HT line and Equipment” or “Permit to work on LT line and Equipment” shall be taken by P&U Dept., depending on the case. Clearance certificate shall also be taken “Trip Reset of HT Equipment” or ”Trip Reset of LT Equipment” as the case may be. For further details refer standard on “ Energy IsolationElectrical and Process”. All concerned shall be trained on “Work Permit System” for proper implementation. 1 day training shall be mandatory for signatory of permit. Further refresher course shall be attended at a gap not exceeding 2 years. Area manager shall kept a record of such training ensure that no untrained person is signing the permit. He shall also initiate action in advance to train the person, whose validity is expiring. RESPONSIBILITIES OF PERMIT SIGNATORIES: FIRE PERMIT SIGNATORY (FPS): FPS shall check the permit, submitted by GSI to assess the safety requirement mentioned in the permit for their adequacy and may check physically some critical checklist compliance such as gas test, isolation, tagging, LOTO implementation etc. and recommend corrective measures before signing the permit. For all critical activities, he will thoroughly check the work site condition (such as hot work in running unit / near OSW lines, working at height, entry in confined space, radiography etc.) and compliance of permit conditions at site before signing. With his experience he may visualize additional hazards/ risks in jobs, which needs to be addressed and will add this in permit for compliance. Before signing he shall ensure that conditions mentioned in permit by GSI is fully complied at site.

8.12

8.13

8.14

9. 9.1

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He should withdraw the permit, if the conditions in permit/ clearance is violated or the job is no more safe due to some other reasons. The information about the withdrawal should be communicated to all concerned. 9.2 GAS SAFETY INSPECTOR (GSI)/ISSUER: To prepare the equipment/ facility/ area properly prepared before handing over for Maint./ Repair/ construction / inspection as per written down procedure. Ensure that equipment/ facility and area is safe for particular work. Permit is properly filled up and precautions are categorically mentioned. Gas test has been carried out, if required. (Gas test is mandatory for hot work and entry into confined space). GSI shall ensure before signing any work permit that the atmosphere tested is gas free or gas levels are within permissible limits for the assigned job and satisfy himself that all necessary precautions have been taken so that the atmosphere remains under control during the work. Avoid giving general/ vague remarks on permit, which is not specific. For working at height, ensure that there is provision of safe access to the work site and there is provision of ladder/ platform/ scaffold for safe execution of work. Check those scaffolds provided are with green tags. Ensure positive isolation of energy and decide about the extent of isolation required for the job. Refer chapter on “Energy isolation- electrical and process. Permit or clearance shall not be issued until and unless he is satisfied that points mentioned in work permit has been fully complied and the area as such is safe to perform the particular work. Positive isolation of all energy sources shall be ensured for confined spaces. Close the permit on completion of work and retain the copy for at least three months. Copies of “ Hot work/ Entry into confined space ” shall be returned to Fire station after close out. Keep your copy of permit always with you. Don’t sign the permit without authority. 9.3 Receiver (Permittee) / Executing Authority: On issue of permit, Receiver (Permittee) should go through the permit and pass the instruction down the line as has been mentioned in the permit for compliance. In case of any doubt, he should clarify from Issuer. Do not sign without authority. Ensure that precautions mentioned in the permit are complied at site. Ensure that equipment being used is safe to perform the task in particular area. Ensure that all power driven equipment including the cables, insulation of cables & cable joints etc. are as per standard and are maintained in healthy condition. Make the permit available at work site all the time during the work. Work at specified location only. Ensure use of approved type of spark arresters on exhaust of every IC engine. The checking and certifying including providing tag on each scaffold shall be the responsibility of executing authority. All jobs shall be done as per established maintenance practices and relevant safety norms. ISMS Standard-1006 Page 15 of 34

Check and ensure availability of valid medical fitness certificate for workmen, working at a height of 2M or above under “Work at Height” permit. Clear the site on completion of work. Close the permit on completion of work and hand it over to issuing authority. 9.4 • REFINERY SHIFT MANAGER Carry out random check of work sites under permit, particularly the jobs at critical locations such as in process units in operation, Tank farm, Gantries, LPG facilities, construction sites etc. and take immediate corrective measures. He will log the same, report to concerned HOD and discuss in RSM meetings. HEAD OF DEPARTMENT • • • 9.6 • • • • To assess necessity of job beyond normal working hours. To assess the adequacy of safety precautions mentioned in permit and may reinforce, if required. May get an independent check to see the safety compliance at site. FIRE STATION OPERATOR (DURING REGISTARTION) Check that authorized signatories have signed the permit at respective column. Permit is properly filled up such as period, location, nature of job etc. and all the columns of the checklist are addressed. Gas test has been done and their reading mentioned in case of Hot work and Entry into Confined Space permit. Report to Shift in-charge of Fire station, if stand by coverage form Fire station has been asked. DEPUTY GENERAL MANAGER • • • • • To check the need of blanket permit for the work and dyke cutting for a tank. Is the area safe for the job for the purpose of blanket permit? To assess the adequacy of safety precautions mentioned in permit and may reinforce, if required. May get an independent check to see the safety compliance at site. For dyke cutting check that resources are mobilized at site to arrest any accidental release of tank containment. WORK PERMIT PROCEDURE / GUIDELINES GENERAL REQUIREMENTS Refinery Management shall issue the appropriate authority limits for various types of permits. For blanket hot work and dyke cutting, permits should be obtained from DGM of concerned area and the facility should be restored as quickly as possible.

9.5

9.7

10. 10.1

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Entire refinery shall be divided into various zones. For each zone, Gas Safety Inspector (GSI) and Fire Permit Signatory (FPS) shall be authorized. Normally, 'A' and 'B' grade officers are made GSI and officers in grade 'C' and above are designated as FPS. In addition, SRSM/RSM shall be authorized as FPS for the entire refinery. All HODs of their respective area are authorized to sign as FPS. Dy. General Manager/General Manager at Refinery units shall authorize Gas Safety Inspectors (GSI), Fire Permit Signatories (FPS) and Permittee/ receivers for all types of work permit. List of authorized Gas Safety Inspectors, Fire Permit Signatories and Permittee/ receivers shall be updated and issued to all concerned at least once in a year. All permits shall be clearly filled for validity of time & date, nature of work and location of work by permittee/ receiver before seeking permit from issuer. For obtaining work permit, permittee shall fill up above information and send duly signed copy to the issuer. Work permit is a document, which certifies that all practicable precautions have been taken for carrying out the job safely. Hence, it is desirable that the work permit form shall be filled up by the GSI after checking and ensuring that the site/ facility / equipment as mentioned in the permit is safe to perform the assigned job. GSI shall satisfy himself that all precautions have been taken to ensure that the work site is free from hydrocarbon & toxic gases and there is no oxygen deficiency and will remain so during execution of the job. After filling the permit format the issuer shall hand over the signed permit to receiver. In case of Hot work/ entry into vessel/ Boxing up of vessel/ excavation/ Vehicle entry permit, FPS has to crosscheck that the preconditions of permit is complied at site, before signing the permit. The receiver will go through the permit, check the compliance and sign the permit before carrying out the job. The receiver will pass the necessary instructions to working personnel as mentioned in the permit before start of job. In case, electricity is involved, GSI shall request P&U Department for electrical isolation in prescribed permit (Annexure-4). No work permit shall be issued unless electrical isolation is obtained. Extent of isolation for safe execution of job shall be as per standard on “Energy isolation- electrical and process” Permits shall be available and displayed at the job site while the job is being executed. The issuer and F&S Dept. shall retain their copies of work permit. All copies of permits shall be collected, signed and returned to the issuing authority after completion of the job by the permittee. It is to be ensured that the area has been cleared of all debris, scraps, additional materials etc. and all temporary electrical connections have been removed. The issuer on receiving back the permit would satisfy himself regarding completion of the job and that the area has been cleaned and made safe for operation. On confirmation he shall also sign the Cold work permit/ Working at height permit/ Radiation permit and keep the records of closed out permit for period of three months. In case of Hot work/ Entry to Confined Space and Excavation permit, the permit shall be forwarded to F&S Department along with the issuer's copy and the record of closed out permit shall be maintained at Fire & Safety Department for a period of three months. ISMS Standard-1006 Page 17 of 34

All permit must be displayed at work site at suitable locations. To protect the permit from weather condition, it shall be displayed in waterproof plastic cover. Wherever required a separate stand may be kept at site to display the permit. In specific cases such as Unit turnarounds the authority to sign / approve the permit can be sub-delegated for specific period by local management by an Office Order, issued by respective GM of the unit. However in all such cases, officers of IOCL be signatories of the permit. The location of hot work and road cut shall be indicated in Red Colour and green colour respectively (colored pin may be used) on refinery layout drawing, displayed in control room of Refinery Fire Station. 10.2 COLD WORK PERMIT Cold Work Permit in Prescribed format shall normally be valid for single shift only and clearance on the same permit can be renewed/ extended up to a maximum of seven calendar days. GSI/ FPS of the area shall issue clearance renewal in each shift after checking permit conditions/precautions and complying the same. GSI/ FPS of the area is authorized to issue the permit. The permit is issued in duplicate. Original (yellow in colour) shall be issued to receiver /executer watermarked as “Executer copy” and 1st copy (white in colour) for issuer shall be watermarked as “Issuer Copy”. Permit shall be considered issued on signature of issuer and receiver. The original permit shall be water marked as issuer copy and duplicate as executer copy. Important Do’s and Don’ts copy (preferably bilingual- English and local language) duly signed by Receiver and Issuer shall be attached to permit for Cold Work Permit. The copy shall be available at site along with original permit copy. 10.3 HOT WORK/ ENTRY INTO CONFINED SPACE Hot work / Entry into Confined Space Permit shall be filled in prescribed form. For each entry into confined space permit, the compliance of “Pre entry check-list for confined space” is a prerequisite. Permit shall be issued in triplicate. The original (Pink in colour) shall be for permittee/ executer shall be water marked as “Executer copy”. The duplicate (white in colour) shall be watermarked as “F&S Dept. copy” and triplicate (green in colour) shall be watermarked as “Issuer copy”. The permit shall be issued equipment wise, specifying the exact location of work. Equipment number shall be categorically specified in the permit. Where the equipment number cannot be specified, the sketch of the area should be enclosed. In such cases the Hot work permit can be obtained for a distance of only 15 M on either side of hot work spot. Beyond 15 M from hot work spot, separate permit is required. ISMS Standard-1006 Page 18 of 34

Normally permit shall be considered issued for the job after “Clearance renewal” is signed by GSI and receiver. This clearance on the same permit can be renewed/ extended up to a maximum of seven calendar days. GSI/ FPS of the area shall issue clearance renewal in each shift after checking permit conditions and ensuring compliance. During Shut down “Hot work / Entry into Confined Space” shall be considered issued for job after “Clearance renewal” is signed. This clearance on the same permit can be renewed/ extended up to a maximum of fifteen calendar days and additional clearance sheets shall be attached with permit for extended clearance renewal. GSI/ FPS of the area shall issue clearance renewal in each shift after checking permit conditions and ensuring compliance of the same. • Blanket hot work permit shall be issued with the authorization of DGM of issuing department for a period of maximum one month, where normal clearance renewal is not required on the same permit. While issuing permit the possible impact of nearby operating areas must be taken into consideration. For Q.C. Laboratory and Workshop or any place, where hot work is required almost everyday and the area is safe for the hot job, the blanket permit can be issued after compliance of permit conditions. Blanket hot work permit can be issued for project construction work in non-operating areas. However, for cutting process lines, specific permit shall be required. However in such cases executer shall constantly keep a watch to ensure that permit conditions are complied at site. For Hot work / Entry into Confined Space Permit after signature by both GSI and FPS shall be registered at Fire Station by F&S operator. Fire and Safety operator shall allot a number on the permit with validity and put his signature. Receiver/ permittee shall retain the original copy (pink in colour), Fire and Safety Department shall retain the duplicated copy (green in colour) and Issuer shall retain the triplicate copy (white in colour). For carrying out “Hot work / Entry into Confined Space”, Permit beyond normal working hours (General Shift) or on Sundays/Holidays, permission shall be obtained from HOD/DGM. In case concerned HOD/DGM is not available on duty, SRSM/RSM may give the permission on instruction from HOD/DGM for emergency/ urgent nature of job. The man way for entry in confined space shall be manned by Attendant all the times, till last man comes out from inside. He shall maintain attendance sheet for all entries in prescribed form. For carrying out Hot work / Entry into Confined Space beyond normal working hours (General Shift) or on Sundays/Holidays, the clearance shall be obtained from SRSM/RSM. Whenever hot job is discontinued at work site for a day due to some reason, when the hot work permit is valid, the executor has to make an entry in prescribed register at Fire Station in advance. Fire station shall be kept informed when no job is done under the valid hot work permit. The compliance of permit conditions must be ensured by signatories ( Issuer & permittee) before restarting the work. ISMS Standard-1006 Page 19 of 34

“Do’s and Don’ts” copy (preferably bilingual- English and local language) shall be attached to permit signed by Receiver and Issuer for “Hot work/ Entry into Confined Space permit”. The copy shall be available at site along with original permit copy. All hot work permit shall get automatically cancelled on occurrence of fire against that permit, unless it is rechecked & certified by issuer & Fire and Safety department officer. All such permits shall be withdrawn and handed over to Fire Station by issuer/ receiver of the permit. For further details about hot work refer Standard on “Hot Work” and for entry into confined space refer standard on “ Confined Space Entry”. All confined space, where man entry has been made against permit shall be boxed up after obtaining “CONFINED SPACE BOX-UP” clearance in prescribed form. Equipment and surrounding areas shall be checked to ensure that they are free from any inflammable gas using a portable gas tester. Frequency of repeating this test or the need for continuous monitoring shall be determined and shall be arranged accordingly. Gas testing of atmosphere shall be mandatory for all hot works and Entry into confined space permit. Any heavy oil deposit, dried vegetation or other flammable / combustible materials within 8 M of a hot work site shall be cleared away. No hot work shall be allowed within 15 M of any sample point, drain or relief valve outlet unless precautions have been taken to prevent the escape of flammable liquids and vapour. If there is any drain or ditches into which flammable liquid can escape, the drain shall be dammed and pumped dry within 15 M of the work site. The outlet of all units drain seals within 15 M of the hot work shall be plugged to isolate them from rest of the drain line. All drain covers and surface manhole covers within 15 M of hot work site shall be covered by flame retardant fabric cloths / wet tarpaulin and wet sand. Particular care shall be taken to ensure that these seals are maintained in good condition. If welding or grinding is to be done at height, then precautions shall be taken to prevent the spread of sparks and molten metal by surrounding the work area with fire-resisting or flame retarding tarpaulin. Arrangement shall also be made to quench and extinguish sparks and molten slag by applying water through a hose. A minimum number of 2 fire extinguishers shall be available for each hot work within 8 M from the place of work.

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A hose with a control type discharge nozzle, capable of reaching up to the hot work point and connected to fire hydrant shall be provided during all hot work. There shall be either be a continuous flow of water through the hose or it shall be kept pressurized up to the discharge nozzle. For detail safety requirements & precautions for hot work refer standard on “Hot Work” and for safety precautions during Entry into Confined Space including gas test, refer standard on “Confined Space Entry”. 10.4 EXCAVATION PERMIT: For excavation permit, permittee shall obtain the Excavation clearance in prescribed format from the respective discipline like Area in-charge, Civil Maintenance, Electrical Maintenance, Telecom, IS, Production/ P&U, Instrumentation, Inspection and Fire & Safety as a prerequisite condition to Permit two days before commencement of work. The clearance form shall be in duplicate. Original for permittee (pink in colour) shall be watermarked as “Executer copy” and duplicate for F&S Dept. (white in colour) watermarked as “F&S Dept. copy”. Permit for excavation shall be in triplicate. Original (pink in colour) shall be watermarked as “Executer copy”, duplicate for GSI (white in colour) watermarked as “F&S Dept. Copy” and third copy (green in colour) watermarked as ”Issuer copy”. For road cutting, approval from HOD of issuing Dept. in Excavation Permit shall be obtained. Additionally the permission for road blockade shall be obtained by E-I-C one day before commencement of working prescribed format. HOD (F&S) shall circulate the road blockade information to all concern one day before commencement of work. For detail please refer Standard on “Safety during Excavation Work”. In case of dyke cutting, permission of concerned DGM hall be obtained in prescribed form. For cutting tank dyke containing Hydrocarbons, the job should normally be carried out between sunrise & sunset and the site should be kept manned all the times. Wherever, job is of continuous nature, the cut dyke should not be left unattended; unless it is temporarily closed with sand bags, G.I sheets etc. to ensure that in case of any leak, the oil should not come out of the dyke enclosure. • The Maximum validity of excavation clearance shall be for 15 days, except in case of construction sites & non-operational areas, where it shall be for a maximum period of 1 month. It shall be obtained at least 2 days before commencement of the work. If the work continues beyond one month, the fresh excavation clearance is required to be obtained. The excavation creance shall be followed by EXCAVATION PERMIT, which shall be obtained at least 1 day before commencement of job. Excavation permit shall be issued in triplicate. On issue, the original (Pink colour) shall be with executer, 1st copy with Fire Station and 2nd Copy with issuer of permit. On issue, the registration of permit is required to be done at Fire station. This will be done for a maximum period of maximum 7 days with renewal in each shift by GSI. However during

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shut down of units/ facilities the permit can be registered for maximum 15 days with shift wise renewal and during construction site for a maximum period of 30 days. • Other appropriate Work Permits are also to be obtained prior to start of excavation work. Copy of excavation clearance shall be attached to the Excavation Permit and serial number of excavation clearance shall be mentioned on the Excavation Permit. In addition to an Excavation Clearance, a Cold Work Permit is required if hand tools are being used for excavation or a Hot Work Permit if powered tools or mechanical equipment are being used. For excavations more than 1.2 meter deep a Confined Space Entry Permit is required. Gas tests shall be done as per entry permit requirements. For any other work inside the excavation, appropriate work permits shall be obtained in addition to above. Executing Dept. officer (executor) shall ensure compliance to precautions specified on the Work Permits and Excavation Clearance. Issuing authority shall monitor these conditions. Each signatory of excavation clearance, who has underground facilities near to excavation site shall monitor the site daily while the excavation is in progress, to ensure that the respective underground facilities are not damaged. Issuer shall check the site for damages before closing the work permit. Excavations adjacent to building, structures, pipe tracks, etc., may require temporary supports or strutting. Concerned civil engineer (executor) shall sign the Work permit and provide the relevant safety recommendations. Certain recommendations may require to be implemented before starting of excavation work. Ladder shall be positioned projecting a minimum of 1 meter above the edge of the excavation. There should be at least two means of exit for persons working inside large excavation within 7.5 meters of travel distance. All walkways across any excavation shall be of scaffold construction with handrails (Refer chapter on Scaffold Safety). Jumping across excavations is not allowed. Executor shall barricade the excavation to avoid the hazard of persons and vehicles falling in. Reflective warning notices, traffic cones and flashing lights (only in non hazardous areas) should also be provided at the edge of excavation and at a safe distance ahead. During night, adequate illumination inside and outside the excavation shall be maintained as long as site is not restored to normal condition. All materials, equipment and excavated soil shall be kept at least one meter away to prevent "fall in" injuries and collapse of excavation. Page 22 of 34

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Executor shall inspect strutting and shoring materials before their use. Minimum section size for poling boards shall be 200mm x 50mm (8" x 2"), while walling 150mm x 50mm (6" x 2") and struts 100mm x 50mm (4" x 2"). Sheeting shall project at least 450mm (18") above ground level to prevent falling objects. Executor shall check the excavation safeguards, shoring, sloping and supporting system daily before starting the job and after every rainstorm or other hazard-increasing occurrence. Engine driven equipment should not be used inside confined excavations. If required, confined space precautions shall be followed. Exhaust gases from the engines of excavators, etc., shall be kept clear of the excavation. Trial excavations shall ensure safety of underground facilities before use of mechanical excavators. Excavation work shall cease if any underground services are discovered or damaged during excavation. Matter shall be reported to the concerned Division without delay. The work shall be restarted only after approval has been obtained from concerned Dept. and a new Work Permit obtained. Executor shall report any damage to underground services or any other incident immediately to the E-I-C and Area in-charge. Prevention of drowning: Adequate fencing, warning notices, etc., are to be provided around an excavation deeper than 1.2 meters and contains enough water to present the risk of persons being drowned. The fencing shall be removed only for the minimum time required for the passage of equipment and materials. If the excavation is in an area where persons could easily gain access, suitable rescue equipment such as safety harness with life line, lifebuoys, rescue jackets, inflatable boats etc shall be provided on or near the site.

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10.5. ELECTRICAL ISOLATION AND ENERGISATION PERMIT • Before issuing any permit for maintenance of equipment, having electrical connection, the Shift-in-charge (Operation) shall request the In-charge of P&U Dept. for isolating equipment electrically through format for “Electrical Isolation and Energisation Permit-HT” or “Electrical Isolation and Energisation Permit-LT” depending on the case. These permits have 3 parts with tear off facility; Part-III shall remain with Equipment custodian/ shift in-charge of operation. Permits are issued in duplicate. Request for isolation shall be made by Shift in-charge to Electrical operation (P&U). After isolation, one portion of permit (Part-I) shall be retuned to Operation in-charge. On completion of work the relevant portion of permit (Part-II) shall be forwarded by Equipment custodian / shift incharge of operation to electrical operation for re-energisation, which shall be done and a copy of permit (Part-II) shall be returned to Equipment custodian / shift in-charge of operation by electrical operation. Page 23 of 34

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Permit to “work on HT line & Equipment” or “work on LT line & Equipment” is an intra departmental protocol of Electrical Department and shall be used by Electrical Maintenance, Electrical Testing and Electrical operation. These permits have 3 parts with tear off facility and is issued in single copy. It shall be initiated by in-charge of electric maintenance (Part-1) and endorsed by Equipment custodian / shift in-charge of operation before forwarding the same to electrical operation for de-energisation. After deenergisation, Permit to work certificate (Part-II) shall be initiated by electrical operation, which will be forwarded to electrical maintenance, who will do the job and issue to Job completion Certificate in same form. Part-III of form for re-energisation shall be done by electrical operational and the certificate for re-energisation shall be issued in same form. “Trip Reset Clearance Certificate for HT Equipment” or “Trip Reset Clearance Certificate for LT Equipment” shall be issued is duplicate by Electrical Operation to Equipment Custodian / Shift In-charge of operation as per requirement . Lock out and Tag Out ( LOTO) of equipments/ facilities will be integral part of the electrical isolation and energisation permit system. After completion of maintenance activity, removal of man and material and clearing of site and ensuring that equipment is safe for operation, owner dept. agency shall declare that equipment is safe for operation and fill the clearance for charging which includes the date and time of returning the permit. After ensuring that equipment is safe for operation the electrical operation group shall energise the equipment. The date and time of energizing the equipment shall be recorded on permit. A list of personnel authorized for issuing electrical permits shall be issued by the HOD (P&U) and be prominently displayed in switchgear room. This list shall be updated annually or whenever there is a transfer/retirement of concerned personnel. For detail procedure refer standard on “Energy Isolation- Electrical and Process”. PERMIT FOR WORKING AT HEIGHT Permit for Working At Height issued in prescribed format shall be considered issued for job after “Clearance renewal” is signed. This clearance on the same permit can be renewed/ extended up to a maximum of seven calendar days. GSI/ FPS of the area shall issue clearance renewal in each shift after checking permit conditions and ensuring the compliance of the same. For carrying out job beyond normal working hours (General Sundays/Holidays, permission shall be obtained from respective HOD. Shift) or on

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• 10.6

Working at height should be avoided in adverse weather conditions, such as during rain, high wind, combination of high temperature & humidity.

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“Pre-Erection Checklist For Scaffold” shall be filled up and requirement shall be fully complied before going for erection of any tubular scaffold. The checklist shall be in duplicate. Original copy shall be for executer and duplicate for issuer. All scaffolds shall be of tubular construction and checked using prescribed format and certified before being tagged. No working at height permit shall be issued unless the scaffold is checked and certified in prescribed form and tagged in green colour, showing “Ready for Use”. In case a scaffold is in continuous use for more than a week, it shall be re-checked and certified at an interval of every week. A scaffold is also required to be checked and certified, whenever any alternation / modification is done in scaffold or if the scaffolds are subjected to severe climatic conditions. All scaffold not ready for use shall be tagged in Red colour. For details please refer chapter on “ Scaffold Safety”. The permit is issued in Triplicate. The original (green in colour) and 2nd copy (white in colour) will be for the Permittee/ Receiver. Issuing authority will retain 1st copy (white in colour). All ladder shall be inspected in prescribed format by custodian once in month. Pre-use of ladder shall be a carried out by user before every use in prescribed format. For formats please refer standard on “Work at Height”. The persons working at height should be medically examines for their fitness for working at height. The format for Medical Certificate is attached. The certified shall be issued by registered medical practitioner and it will be valid for a period not exceeding 1 year. 10.7 RADIATION PERMIT Radiation Permit shall normally be issued valid for single shift only and clearance on the same permit can be renewed/ extended up to a maximum of seven calendar days. GSI/ FPS of the area shall issue clearance renewal in each shift after checking permit conditions. Radiation permit is divided into two parts. Part-2 will be filled by radiography agency and officer of inspection department will endorse the permit. The permittee/ receiver shall fill the permit for validity of time & date, nature of work and location of work before seeking permit from issuer. For obtaining work permit, permittee shall fill up above information and send duly signed copy to the issuer. After checking and filling the Part-1 of the permit format the issuer shall hand over the signed permit to receiver. The receiver will go through the permit, ensure the compliance and sign the permit before starting the job. GSI/FPS of the area is authorized to issue the permit. The permit is issued in duplicate, the original copy (Blue in colour) for receiver shall be water marked as “Executer copy” and duplicate copy (white in colour) for issuer shall be watermarked as “Issuer Copy”. 10.8 Issue Of Permit

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Permittee i.e. under whose direct supervision the job is to be carried out shall raise the requirement for appropriate permit. All permits shall be issued in triplicate/ duplicate. Based on type of job, following permit shall be used: Cold Work Permit Hot Work/ Entry into Confined Space Permit Excavation Permit Permit for Working at Height Radiation Permit The permit for “Electrical isolation and Energisation Permit” shall be initiated by custodian of equipment (Operation in-charge), whereas “Permit to Work on High Tension/ Low Tension Line / Equipment shall be initiated by in-charge of electrical maintenance. In case the job is planned to be executed through a contractor, permit shall be raised and signed by maintenance/project/ construction engineer and not by the contractor. The period of validity, in terms of the date, start time and completion time should be entered. The location of the work shall be specified clearly in terms of the plant, plant area, building, vessel or equipment. Identification number of the equipment shall be mentioned. Wherever it is necessary location sketch should be attached with the permit for clarity. Area in-charge / GSI shall check the permit conditions prescribed in the format. Permit shall be issued only after satisfying all the conditions. Additional precautions and remarks, if any, shall be clearly mentioned. All the items shall be marked appropriately in the boxes under heading “Done” and “Not Required”. Explanatory Notes To Work Permit On “Cold Work, Hot Work/ Entry to Confined Space” Explanatory notes to fill up the work permit and its check-listed items are elaborated below to amplify the underlying concepts and highlight their significance:

a. b. c. d. e. •

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10.9

a. Exact Location (Area / Unit / Equipment no): Exact location of the area or the unit in which the work is to be carried out shall be written against it. For example; AVU / 12 C 101, Tank farm A, Tank 501 etc. b. Description of work: Precise description of the work to be performed shall be written. Sketches with signature should be attached wherever possible to avoid miscommunication. c. Equipment / Area inspected: Equipment or area where work is to be conducted, should be inspected to ensure that it is safe to carry out the work and assess other safety requirements / stipulations. In case of equipment / vessel box-up permit, it should be ensured that the work is complete, all personnel are out, no maintenance gear is left behind and debris removed. ISMS Standard-1006 Page 26 of 34

d. Surrounding area checked / cleaned: Unsafe conditions for performance of work may arise from surrounding area. It should be cleaned-up to remove flammable material such as oil, rags, grass etc. e. Sewers, Manholes, Closed Blow Down (CBD) etc. and Hot Surfaces covered: Flammable gases may be released from nearby sewers. Hot un-insulated surfaces (equipment / pipelines) may provide a source of ignition and therefore, these are to be properly covered to prevent fires. f. Hazard from other routine / non-routine operations considered and persons alerted: Other activities (routine / non-routine) being carried out near-by, which can create conditions unsafe for performance of the permit work, should be taken into consideration and the concerned persons should be alerted accordingly. g. Equipment electrically isolated and tagged: Before issuing a permit, it shall be ensured that electrical isolation has been done, switches are locked-out and cautionary tags duly signed with date and time are attached. h. Running water hose / Portable extinguisher provided / Fire water system available: Running water hose and portable fire extinguisher are required to flush / dilute in case of release of any hazardous chemical or to quench sparks and to put out small fires immediately. In order to meet any contingency, it should be ensured that the fire water system including firewater pumps, storage, network etc. is checked and kept ready for immediate use. i. Equipment blinded / disconnected / closed / isolated / wedge opened: Equipment for which the work permit is being issued, should be isolated from the rest of the plant in order to ensure that there is no change in the work environment with respect to presence of toxic / flammable gases, liquids, hazardous chemicals etc. in the course of the work. Blinding is one of the most effective ways of isolation. Blinds should be installed as close to the equipment as possible. If lines cannot be blinded, these should be disconnected and the open ends should be made safe by installing pipe caps / plugs, blind flanges etc.

j. Equipment properly drained / depressurised: Equipment under pressure should be depressurised after isolation. This should be followed by draining / purging / water flushing etc. as the case may be. k. Equipment containing liquid hydrocarbons should be drained completely. There may be a possibility of overlooking of liquid collected in pockets or inaccessible areas such as level gauges, small nozzles / bleeders on vessels, laterals in pipe work etc. All low point drains should be in unplugged condition. l. Equipment properly steamed / purged: Purging of equipment (tanks, vessels, pipelines etc.) is done to make them free of flammable hydrocarbon and toxic gases. Steam / Inert Gas is used for gas freeing of vessels and pipes in refineries and other locations. Other means of purging is by displacement with water and final traces of gas removed by properly earthed air eductor. All high point vents should be unplugged while purging. It Page 27 of 34

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should be done in a systematic manner to cover the entire equipment / plant and continued till the concentration of toxic / flammable gas is lowered to allowable level. m. Equipment water flushed: Water flushing is an effective means of cooling, cleaning and even gas freeing of equipment. It is also employed to remove traces of acids / chemicals. Equipment metallurgy must be considered before using sea / saline water. Sometimes, flushing with demineralised water would be necessary depending upon the metallurgy of the equipment. n. Gas / Oxygen deficiency test done: Gas test includes measurement of: • • • • Hydrocarbons by Explosive meter. Oxygen Deficiency by Oxygen Meter. Toxic gases like Hydrogen Sulphide, Carbon Monoxide, Sulphur dioxide by multi-gas meter. Nickel Carbonyl, and Chlorine etc. by techniques like Indicator Tube method, Lead Acetate Paper etc. For details of gas testing refer standard on “Confined Space Entry”. o. Shield against sparks provided: Hot works like welding, grinding etc generates sparks, which can provide source of ignition to the surroundings. In order to protect operating area from the hazards of sparks generated, shields are to be provided to contain the sparks generated. The shield material shall be non-flammable and should be kept wet with water. p. Proper ventilation and lighting provided: Where natural ventilation is not available, fans / air eductors are provided. These are also required for speedy dispersal of fumes generated by welding job. Only approved reduced voltage extension lights (not exceeding 24 volts) are to be allowed for work inside confined space from consideration of personal safety. q. Proper means of exit provided: Proper means of exit is required in case of emergencies developed on account of the work or otherwise. Availability of an alternate route of escape should be considered. r. Area cordoned off and caution boards provided: To prevent any unwarranted entry in the work area and also to caution other personnel taking actions which may endanger people working on the permit job, precautionary tags / boards are to be provided to display like "No Entry" sign on roads or "Caution - Men at Work Inside" on the manhole of a vessel, "Danger - Radiography in progress" etc. s. Portable equipment / Hose nozzles properly grounded: As a precaution against static electricity generation, portable equipment / hose nozzles e.g. nozzle of a shot blasting gun, are to be grounded. Use of hydrocarbon lines for earthing should be avoided. 30 mili-amp circuit breaker shall be installed on electrical circuits / cables feeding power supply to portable equipment.

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t. Trained Attendant provided for entry to confined space: Whenever a person is entering in a confined space, minimum two designated trained persons shall be kept at the man-way or entry point. The designated person shall be in constant communication with the persons inside the confined space and take corrective action in case of any emergency situation. u. Standby personnel provided for fire watch from Process / Maintenance / Contractor / Fire Department: Depending on the criticality of the job, work permit issuer shall decide the type of standby to be provided i.e. from which department, of which level, how many and also additional fire fighting support facilities etc. v. Iron Sulphide removed / kept wet: Pyrophoric substances may be present in operating area / equipment handling hydrocarbon. Iron Sulphide scale is the most common pyrophoric substance encountered. These should be either removed to safe locations or kept wet all the time to prevent their auto-ignition. w. Checked spark arrestor on mobile equipment: No vehicle / engine without PESO approved spark arrestor shall be permitted in operating areas. x. Checked for oil / gas trapped behind lining in equipment: Before undertaking hot jobs, a check should be done for oil / gas trapped behind lining in the equipment. y. Communication Facility to stand by persons : Adequate communication facility (if required intrinsically safe or hand free communication) shall be provided to standby persons to remain in touch with persons inside confined space during the job and respond quickly, if help required. z. Attendant person with rescue equipment/ SCBA : Attendant at man-way of confined space shall be trained in rescue and use of respirator equipments and shall have the facility at site, to extend help whenever required. He shall communicate effectively to emergency teams, if so required. aa. Continuous inert gas flow arranged: This is required where entry into confined space is required in inert atmosphere. The continuous inert gas flow shall be arranged in order to maintain the oxygen concentration and other gases within limit. 10.10 Precautions For Working At Height: 10.10.1 Scaffolding (Refer Standard on Scaffold Safety) (i) The erection of any tubular scaffold shall not begin before the checking of scaffold material at site (w.r.t quality and quantity), preparations at site, availability of PPE, availability of trained personnel for erection etc. in prescribed format on “ Pre Erection Checklist for Scaffold”. The requirements of checklist must be complied before start of erection of scaffold at site. This check-list shall be filled up in duplicate. The original shall be retained by executer and 1st copy with issuer (area in-charge). All scaffolds after erection must be checked and certified in prescribed form by scaffold supervisor and Officer of executing Dept. Page 29 of 34

(ii)

ISMS Standard-1006

All scaffolding shall be inspected after completion of erection and then at least every seven days or after weather likely to have affected stability of scaffold or on all alterations. (iii) All Scaffolds, which has been checked and certified for use shall be tagged with “Green card” duly filled and signed by scaffold supervisor and Officer of executing Dept. All incomplete scaffold, scaffold under modification/ alteration / not fit for use shall have “Red tag” , Green Tag: Means scaffold is safe for use. The tag should be properly filled –up and signed. Red Tag: Means not for use. (iv) Scaffold erected on firm ground and sole plate & base plate have been used. A good base is essential, so that the ground or floor on which the scaffolding is going to stand should be carefully examined. Soil or made up ground will need consolidating. Sole plates at least 9" x 1½" (230 mm x 40 mm) cross section are required to spread the load on earth, made up ground, asphalted surface etc. Sole plates shall extend under at least two standards and joints shall be positioned so that they fall within one half to one third of the distance between any two adjacent standards. At the end standard the sole plate shall project a similar distance. No sole plate is required if scaffold is erected on concrete surface. However base plates are compulsory for all scaffolds. Platforms have been provided with Toe board, guardrail & area below is barricaded. TOE-BOARD (Also known as a Kicking Board) - A board positioned at the edge of a platform or place so as to prevent persons, tools and materials falling from the platform or place. GUARDRAIL - (Also known as a Handrail) - A tube connected at the edge of platform and other places to prevent persons falling from platform or place at a height of about 1M form platform. For all work platforms TRAP means any gap in floor of platform or 1” of more, TRIP means overlapping of scaffold boards or any projection on floor of platform, which may cause trip of person and FREE FROM FALL means the platform provided with adequate Toe guard, Guard rail and Mid-rail to avoid any fall from height. (vi) Proper means of access to the scaffold including use of standard aluminum ladder shall be provided. Access to a working platform is best achieved by providing a separate ladder tower (for high scaffolds) or cantilevered access platform so as not to obstruct the platform and to minimize the possibility of persons falling through the gap in the guardrail or decking For details of scaffold refer Standard on “Scaffold Safety”. 10.10.2Roof Work (For detail refer Standard on “Working at Height”)

(v)

ISMS Standard-1006

Page 30 of 34

i) ii) iii) iv) v) vi) vii)

All roof-work operations should be pre-planned and properly supervised. Roof work shall only be undertaken by workers who are physically and psychologically fit and have the necessary knowledge and experience for such work. Work on roofs shall not be carried on in weather conditions that threaten the safety of workers. Crawling boards, walkways and roof ladders shall be securely fastened to a firm structure. Roofing brackets shall fit the slope of the roof and be securely supported. Where it is necessary for a person to kneel or crouch near the edge of the roof, necessary precautions shall be taken. On a large roof where works have to be carried out at or near the edge, a simple barrier consisting of crossed scaffold tubes supporting a tubing guardrail may be provided. For detail refer Standard on “Working at Height”. All covers for openings in roofs shall be of substantial construction and be secured in position. Roofs with a pitch of more than 10 shall be treated as sloping. When work is being carried out on sloping roofs, sufficient and suitable crawling boards or roof ladders shall be provided and firmly secured in position. During extensive work on the roof, strong barriers or guardrails and toe-boards shall be provided to stop a person from falling off the roof. Where workers are required to work on or near roofs or other places covered with fragile material, through which they are liable to fall, they shall be provided with suitable roof ladders or crawling boards strong enough and when spanning across the supports for the roof covering to support those workers. A minimum of two boards shall be provided so that it is not necessary for a person to stand on a fragile roof to move a board or a ladder, or for any other reason.

viii) ix) x) xi) xii)

xiii)

10.10.3 Work on Tall Chimneys i) ii) iii) iv) v) • • vi) For the erection and repair of tall chimneys, tubular scaffolding shall be provided. A safety net shall be maintained at a suitable distance below the scaffold. The scaffold floor shall always be at least 65 cm below the top of the chimney. Under the working floor of the scaffolding the next lower floor shall be left in position as a catch platform. The distance between the inside edge of the scaffold and the wall of the chimney shall not exceed 20 cm at any point. Catch platforms shall be erected over: The entrance to the chimney; Passageways and working places where workers could be endangered by falling objects. For climbing tall chimneys, access shall be provided by: Page 31 of 34

ISMS Standard-1006

(a) (b) (c) vii)

Stairs or ladders; A column of iron rungs securely embedded in the chimney wall; Other appropriate means such as access tower, elevator etc. When workers use the outside rungs to climb the chimney, a securely fastened steel core rope looped at the free end and hanging down at least 3 m shall be provided at the top to help the workers to climb on to the chimney. While work is being done on independent chimneys the area surrounding the chimney shall be enclosed by fencing at a safe distance. Workers employed on the construction, alteration, maintenance or repair of tall chimneys should not:

viii) ix) • • • • • • • •

Work on the outside without a safety harness attached by a lifeline to a rung, ring or other secure anchorage; Put tools between the safety harness and the body or in pockets not intended for the purpose; Haul heavy materials or equipment up and down by hand to or from the workplace on the chimney; Fasten pulleys or scaffolding to reinforcing rings without first verifying their stability; Work alone; Climb a chimney that is not provided with securely anchored ladders or rungs; Work on chimneys in use unless the necessary precautions to avoid danger from smoke and gases have been taken. Work on independent chimneys shall not be carried on in high winds, icy conditions, fog or during thundering/lightening. All persons intended to work on chimney shall be exposed to medical examination and must carry valid Medical Certificate, showing their fitness for the job in prescribed form. Validity of such certificate shall be only 1 year.

x)

10.11 Surrendering of Work Permit On completion of a Cold work, Radiation and Working at height, the permits (original with copies) shall be signed by permittee and returned to the issuer. The issuer shall retained the copies of various permits in chronological order in folder for a period of minimum 3 months from the date of closure of permit or from the date of commissioning of facilities, whichever comes later. On completion of a “Hot work/ Entry to Confined Space” and “Excavation”, the permit (original and copies) shall be signed by permittee and returned to the issuer along with clearance certificate. The issuer will then send the permits to F&S Department along with their copies. F&S Department shall record the completion of the job and keep the permits (with all copies) for record. Hence, after completion of the job, shift in-charge of F&S shall retained the copies of various permits in chronological order in folder for a period of minimum 3 months from the date of closure of permit or from the date of commissioning of facilities, whichever comes later.

ISMS Standard-1006

Page 32 of 34

In case of serious lapse or violation of permit conditions, where safety of the working personnel or equipment is likely to be affected, the execution of the job can be stopped by permit issuing/ executing dept, Fire and Safety personnel, RSM or any other personnel authorized by the management for the purpose. In case of any accident or fire at the work site, the permit shall get automatically cancelled. Fresh permit shall be obtained for restarting the job. 10.12 Surveillance and Withdrawal of permit The permit issuing authority and executing authority shall inspect the work site frequently to ensure that permit conditions are being complied and maintained. Officers and staff of F&S Dept. shall make surprise checks at the sites where jobs against work permit are in progress. Surprise checks shall be carried out on a structured checklist and findings shall be documented. Date and time of such surprise checks shall be recorded. The corrective measures shall also be taken. The permit can be withdrawn by issuing authority, executing authority, F&S personnel, RSM or any person authorized by management in case of violation of permit condition, plant emergency or any other unsafe situation. 11. Training and Awareness Any person who is authorized to issue or receive the work permit shall be imparted training for a period of not less than one day covering various aspects of work permits system. Further all the person authorized to issue/ receive the work permit shall be given a minimum of one day training once in two year on the work permit system and records maintained. Training and awareness programs are to be organized from time to time for issuer & receiver of permit to make them conversant about work permit system. These programs should include “class room” as well as “on the job training” like • • • • Filling of permits, assessing hazards and correction, Work Permit procedure Atmosphere monitoring with portable gas testers. Use of PPE including SCBA & airline respirators Carrying out different jobs safety Awareness programs should be arranged in the form of “Class room training” as well as “On the job training” for contractors (Supervisor and their workmen) about work permit system. 12. REVIEW Review of work permit system shall be carried out at least every once two years or following a major and/or high-potential incident / accidents or change in statuary requirements / norms. ISMS Standard-1006 Page 33 of 34

13.

AUDIT OF WORK PERMIT SYSTEM The Work Permit System shall be audited at least annually by a multi disciplinary team constituted by refinery management for the purpose. For the audit the detail format shall be developed by the refineries. The audit shall include checking of procedure for permit/ clearances being followed and physical check at site. The guidelines for audit checklist are as follows: • • The permit, clearances and format have been properly filled up and recommendations are mentioned categorically. The permit signatories including HOD and DGM are trained and they have been trained within 2 years. Check the content of training program to assess the coverage on “Work Permit System” . Ask questions from workmen, supervisors, and signatories of permit about their knowledge on subject to assess the effectiveness of training program. Check for training record of toolbox talk and effectives of training. Check for detail procedure including closing of permits, record keeping. Check work sites to observe deviation from procedures, permits, clearances and format. REFERENCE • • • • • • • • OISD STD.-105 OISD GDN-192 PETROLEUM ACTS & RULES AND FACTORIES ACT OSHA STD- 29CRF 1910.146 OSHA 1910.1200 SAFE WORK IN CONFINED SPACES BOOKLET BY HSE, UK GUIDELINES ON SAFETY, HEALTH & ENVIRONMENT MANAGEMENT SYSTEM BY IOCL, SHE, CO. SAFETY MANUALS OF IOCL REFINERIES

• • • 14.

ISMS Standard-1006

Page 34 of 34

ANNEXURE-1 Format No. IOCL/Name of Refinery/CW/ 01 INDIAN OIL CORPORATION LTD. Sl. No. ____________ REFINERY COLD WORK PERMIT

Work clearance From : __________ Hrs. of date_________ To ________ Hrs. of Date________ Issued to (Department/ Section/ contractor) ……………………………………………………………….. Exact Location of work (Area/ Unit/ Equipment No. etc.) ……………………………………………. Nearest Fire Alarm Point : Description of work ___________________________________________________________________________ Sign. of Permittee _____________ THE FOLLOWING ITEMS SHALL BE CHECKED BEFORE ISSUING THE PERMIT (Tick mark in the appropriate box. Checklist items marked with asterisk ( * ) shall be complied by receiver) Sr Item Done Not Sr Item Done Not No. Reqd. No. Reqd. 1 Equipment / Work Area 6 Equipment water flushed inspected 2 Surrounding area checked, 7 Equipment properly cleaned and covered steamed / purged 3 Equipment 8 Proper ventilation and blinded/disconnected / lighting provided closed / isolated / wedge opened 4 Equipment properly drained 9* Area cordoned off & and depressurized caution boards / tags provided. 5 Equipment electrically 10 Gas test: HC / Toxic etc. isolated and tagged vide HCs = % LEL Permit no. ------------------Toxic gas = PPM Remarks: 1. The activity has the following expected residual hazards (Tick the relevant items): Lack of Oxygen H2S Gas Toxic Gases Combustible gases Pyrophoric Iron Steam Condensate Corrosive Chemicals Others , if specify

1

2. Following additional PPE to be used in addition to standards PPE (Helmet, Safety Shoes, Hand gloves, Boiler suit) (Tick the relevant items): Face Shield Goggles Dust Respirator Fresh Air Mask Lifeline Safety Harness Compressed Air Set Earmuff Others

3.Additional precaution if any: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ FIRE PERMIT SIGNATORY (FPS) / GAS SAFETY INSPECTOR (GSI)/ ISSUER Signature :____________ Date _________ Name: ____________________________ Designation: ___________Tel. No.: ______ PERMITTEE (RECEIVER) Signature :_____________ Date _________ Name: ______________________________ Designation: ___________ Tel. No.: ______

Closing of the work permit: Receiver : Certified that the subject work has been completed / stopped and area cleared Issuer: Verified that the job has been completed and area cleared and is safe from any hazard.

Date & Time

Name & Designation

Signature

Date & Time

Name & Designation

Signature

2

Clearance Renewal: Time Date From To Gas Test Additional Reading precautions if any,

( Permit No : Issuer Name and designation of GSI / FPS Receiver Signature of Permittee

Signature Name and of Desig. of GSI / Permittee FPS

3

General Instructions: 1. The work permit shall be filled up carefully and accurately in clear handwriting ensuring that complete information is provided in all the sections / subsections and none of column is left blank. Sketches should be provided wherever possible to avoid miscommunication. 2. Appropriate safe guards and required personnel protective equipment (PPEs) shall be determined by a careful analysis of the potential hazards and the operations to be performed prior to starting the work. 3. Requirement of standby personnel from Process / Maintenance / Contractor / Fire & Safety etc if any shall be mentioned in the additional requirement. 4. In case of fire alarm all work must immediately be stopped. In case of Emergency Sirens, all work must be stopped and all nonessential personnel must leave work site and processed to designated areas. 5. For renewal of work clearance, the issuer shall ensure that the conditions are satisfactory for the work to continue. If the conditions have changed, it may be necessary to issue a new permit or amend the existing permit. 6. This permit shall be valid for a period of 8 hours only, unless it is renewed/ extended. This clearance on the same permit can be renewed / extended up to a maximum of seven calendar days. 7. Original permit must be available at work site at all times. 8. On completion of the work, the permit shall be closed and returned to the issuer. 9. The permit shall be issued in duplicate. Original permit (Yellow) shall be issued by receiver/ executer and duplicate (White) shall be retained by issuer. 10. Enclose important Do’s and Don’ts duly signed with each permit. 11. Safety Toolbox talk has to be ensured by receiver before start of work and record for the same shall be maintained. 12. Obtain separate permit for “Working at Height”, if required.

4

___________ REFINERY

ANNEXURE-2

DO’S & DONT”S FOR COLD WORK (Attach with all Cold work permit)
Permit No.-

Do’s:
1. 2. 3. 4. 5. Ensure the availability of valid work permit before start of work. Ensure that work permit conditions are fully complied at site. Equipment should be properly isolated from all sources of energy before start of work. Ensure that walkways and passages are free from all slip/ trip and fall hazard. All draining of oil should be in closed OW&S system and the draining of oil on floor will make the work area and area around the work unsafe. 6. Ensure proper illumination of work place while working in dark. 7. Ensure use of non-sparking tools in Hydrogen/ Flare / LPG / etc. service lines / Equipment and areas such as in LPG storage, bottling and loading area, HGU, Gantries etc. 8. Executor should ensure the quality of hand tools and their health. 9. Always first wedge open the flanges. 10. Use of proper PPE must be ensured during cold work by executor. Use of safety helmet and shoe is mandatory for all works inside refinery 11. While carrying out cold work inside confined space, proper ventilation and illumination should be ensured before start of job. 12. Electric cable should be free from joints with sound insulation. Portable electrical equipment should have no loose connections. 13. All portable/ mobile electrical equipment should be connected with ELCB. 14. Executor should ensure that the lifting machine (Crane), tools & tackles are properly tested and SWL and date of testing is displayed on equipment. 15. Barricading of the area below lifting machine (Crane), chain pulley blocks etc. should be ensured before starting the job. 16. Gas test should be carried out before issuing cold work permit, wherever required. 17. Remove all scarps and unused material from site on completion of work. 18. Executor should know the nearest Fire Alarm point, Fire Order, Fire Station phone number (…………..), First-Aid center phone no. (……….), nearest safety shower, Escape route & location of designated assembly points and siren code before start of work.

Don’ts:
1. 2. 3. 4. 5. 6. Never stand or work under suspended loads. Never enter work area without safety helmet and shoe. Do not wear loose/ synthetic cloths while on work Do not use short cuts on work Do not use lamp of more than 24 V while working in confined space. Do not run a machine without putting back the guard on it’s exposed moving part.

(Signature of receiver)

(Signature of issuer) 5

WORK PERMIT SYSTEM
ANNEXURE – 2
Format No.: IOCL/Name of Refinery/HW-CS/XX
Sl. No.:

Indian Oil Corporation Ltd. (Refineries Division) ________REFINERY PERMIT FOR HOT WORK / ENTRY INTO CONFINED SPACE
(Strike out if not applicable)
PERMIT TYPE NORMAL SHUT DOWN

Permit Regn. No.: Previous Permit Regn. No.: Registered by: ____________(Signature) Name: ___________________________ Date: _____________
Please tick [√] in required permit type

BLANKET

Work Clearance From ______ Hrs.of date _________ To ______ Hrs. of Date _________ (Valid for the shift unless renewed) Issued to (Department / Section / contractor) _________________________________________ Work order No. ___________________ Exact Location of work (Area / Unit / Equipment No. etc.) _____________________________________________________________________________ _____________________________________________________________________________ Nearest Fire Alarm No.__________ Description of work _____________________________________________________________ ___________________ Name of Permittee __________________________ Date ___________ [Signature of Permittee]

FOLLOWING ITEMS SHALL BE CHECKED BEFORE ISSUING THE PERMIT
[Please put tick [√] in the appropriate box. Checklist items marked with asterisk (*) shall be complied by receiver. For hot job in confined space, Sl. No.: B13 shall be ticked for “Done” only]

Sr. Item No. A General points 1 Equipment / Work Area inspected 2 Surrounding area checked, cleaned and covered 3 Sewers, manholes, CBD etc and hot surfaces nearby covered 4 Considered hazard from other operations and concerned persons alerted. 5 Equipment blinded/disconnected / closed / isolated / wedge opened 6 Equipment properly drained and depressurized 7 Equipment properly steamed / purged 8 Equipment water flushed 9 Free access for approach of fire tenders has been

Done

Not Sr. Not Item Done Reqd. No. Reqd. 10 Iron sulfide removed / kept wet 11 Equipment electrically isolated and tagged vide permit no. 12 Gas Test: HCs = % LEL; O2 = % Toxic gas = ppm, 13* Running water hose / Fire extinguisher provided. Fire water system available. 14* Area cordoned off and Precautionary tags / Boards provided. For Hot work / Entry to confined Space 1 Proper ventilation and Lighting providing 2 Proper means of exit / escape provided 3 Standby personnel provided from Process / Maint / Contractor / Fire / Safety dept. 4 Checked for oil and Gas trapped behind the lining in Equipment 5* Shield provided against spark 6* Portable equipment / nozzles properly grounded

ISMS STANDARD – 1006

1

maintained.

7* Attendant at man way provided for entry into confined space (2 Persons) Not Reqd.

Sr. No.

Not Sr. Reqd. No. For Hot work / Entry to confined Space Item Done

Item

Done

8* Adequate communication provided to stand by person. 9* Trained Attendant provided with rescue equipment/ SCBA. 10 Space adequately cooled for safe entry of person. 11 Continuous inert gas flow arranged. 12 Check for Earthing / ELCB of all temporary electrical connections being used for welding

13* Gas cylinders are kept outside the confined space. 14* Checked spark arrestor on mobile equipments 15 Welding machine checked for safe location 16 Permit taken for working at height vide permit no. For Vehicle Entry 1* Approved type Spark Arrestor on the mobile equipment / vehicle provided.

X

Remarks: 1. The activity has the following expected residual hazards [Tick (√) the relevant items]:
O2 Deficiency H2S Gas 2. Toxic Gases Combustible gases Pyrophoric Iron Steam Condensate Corrosive Chemicals Others Please specify others

Following PPEs shall be used in addition to standard PPEs i.e. Helmet, Safety Shoes, Hand gloves & Boiler Suit [Tick (√) the relevant items] Face Shield Dust Respirator Fresh Air Mask Lifeline Safety Harness Compressed Air set Ear Muffler Others (if any), Please specify

Goggles 3.

Additional Precautions [if any]_____________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Signature Designation Name Date Tel. No.

Recipient Fire Permit Signatory (Issuer) Gas Safety Inspector (GSI) Permittee / Receiver Functional DGM [#] Concerned Area HOD / RSM [**] Executing HOD [**]

Not Applicable - Do - Do -

[**]: Concerned Area HOD / RSM shall sign when Hot Work / Entry into Confined Space Permit is needed beyond normal working hours / round the clock / Sundays & holidays. [#]: Functional DGM shall sign if the Job requires blanket permit where clearance renewal is not required.

ISMS STANDARD – 1006

2

Closing of Work Permit
Receiver Certified that the subject work has Declaration been completed / stopped and area cleaned. Signature Name Designation Date Time [hrs.] Attributes Issuer F&S Department Verified that the job has been Closed Permit completed and area cleaned and is Received safe from any hazard.

General Instructions:
1. 2. 3. 4. 5. 6. 7. Work Permit shall be filled up carefully and no column shall be left blank. Provide sketches, if required. Appropriate safe guards and PPEs shall be determined by analysis of the potential hazards prior to starting the work. In case of fire alarm all work must immediately be stopped. In case of Emergency Sirens, all work must be stopped and all non-essential personnel must leave work site and proceed to designated areas. Only certified vehicle / engines and permitted type of electrical equipment and tools are allowed in operating areas. Welding machines should be located in non-hazardous and ventilated areas. Gas test is mandatory. No hot work shall be permitted unless the explosive meter reading is Zero. Vessel entry, where no hot work is to be carried out, shall be permitted if combustible gases are up to 5% of lower explosive limit [LEL]. Entry with an air-supplied mask shall be permitted with LEL of up to 20%. The Oxygen level shall be at least 19.5% vol. and the concentration of toxic gases below the threshold limits [TLV of H2S: 10 ppm & CO: 50 ppm]. When a person is entering confined space, the receiver must keep minimum two trained attendantsdesignated persons at the manhole or entry point. For renewal of work clearance, the issuer shall ensure that the conditions are satisfactory for the work to continue. If the conditions have changed, it should be necessary to issue a new permit or amend the existing permit. Permit shall be considered issued for job after “Clearance renewal” is signed. This clearance on the same permit can be renewed / extended up to a maximum of seven calendar days, except in case of plant shutdown, where permit can be issued for a maximum period of 15 days. Blanket permit may be issued for a maximum period of 30 days. During the registration period of permit, if job is not done for a day or more (except holidays/ Sundays), receiver shall enter in prescribed register at Fire Station in advance about the discontinuity of job. This permit must be available at work site at all times. On completion of the work, the permit must be closed and submitted to F&S as record by receiver. Hot work shall include welding, grinding, gas cutting, burning, open flame, soldering, shot blasting, chipping, riveting, drilling, camera flashing, power tools, IC engines, Mixer machines, use of certain non explosion proof equipment, vehicle entry or any other activities which may generate heat or spark. The permit shall be issued in triplicate. Permittee shall retain pink copy, first copy shall be retained with F&S and second copy shall be remained with issuing authority, all these copies shall however bear the Fire Station Registration Number. Permit issuing authority, RSM & F&S personnel or any authorized officer can check the permit / stop the job and even cancel the permit on safety norms violation any time. Enclose important Do’s and Don’ts duly signed with each permit. All precautions given in permit must be clearly adhered by the permittee. Daily Toolbox talk / safety briefing to be ensured by the permittee before start of job. A register on toolbox talk shall be kept at site as record and signed by personnel associated with the work.

8. 9.

10.

11. 12. 13. 14.

15.

16. 17. 18. 19.

ISMS STANDARD – 1006

3

20. Pre-use check of portable gas testers must be done to ensure its operability by GSI before the gas test at work site.

Clearance Renewal:
Signature With Name and Designation Signature of Concerned area HOD** Endorsement by F&S** Additional Precautions [if any], Otherwise mention “NIL” Time [hrs.] Gas Test Values for HC, Toxic and O2 etc. [Write names of toxic gases______ ___________ ___________ __________] Gas Test: HC: %LEL Toxic: PPM % O2 : Gas Test: HC: %LEL Toxic: PPM O2 : % Gas Test: HC: %LEL Toxic: PPM % O2 : Gas Test: HC: %LEL Toxic: PPM O2 : % Gas Test: HC: %LEL Toxic: PPM % O2 : Gas Test: HC: %LEL Toxic: PPM % O2 : Gas Test: HC: %LEL Toxic: PPM O2 : % Gas Test: HC: %LEL Toxic: PPM % O2 : Gas Test: HC: %LEL Toxic: PPM O2 : % Gas Test: HC: %LEL Toxic: PPM O2: %

From

GSI / FPS

Permittee

(**): When Work Permit has been issued for Normal Working Hours but work is anticipated to be extended beyond Normal Working Hours, concerned area HOD shall endorse permission with signature

ISMS STANDARD – 1006

RSM

Date

To

4

In case of Fire, dial_________
___________ REFINERY Do’s & Don’ts For Hot Work
[This page shall be enclosed with all Hot Work Permit]

ANNEXURE – 2A

Permit Regn. No.:

Do’s:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Ensure the availability of valid work permit and clearance before start of work. Ensure that work permit conditions are fully complied at site. Area shall be free from all flammables & combustibles and the OWS man-ways, drains etc., where there is likelihood of presence of hydrocarbon during the course of work shall be covered and sealed. In case of gas welding/ cutting, cylinders (acetylene cylinder must) should be kept in upright position and these should be easily identifiable by its colour. Hose connections of gas cylinders should be checked before starting of hot job. The hoses must be free from all cuts & kinks and distinct in color (Maroon for acetylene and black for oxygen). Executor must ensure use of proper PPEs during hot work. In case of welding/ cutting/ gauging etc., it should be ensured that spark is arrested at site only, especially while carrying out hot work at height. Executer shall ensure use of flash back arrestor in gas cylinders while using oxy-acetylene sets. Use welding lighters only to light the welding torch. While carrying out hot work inside confined space, proper ventilation and illumination should be ensured before start of job. Electric cable shall be free from joints with sound insulation. Portable electrical equipment should have no loose connections. All portable/ mobile electrical equipment shall be connected with ELCB. Executor shall ensure that the lifting machine (Crane), tools & tackles are properly tested and SWL and date of testing is displayed on equipment. Barricading of the area below lifting machine (Crane) should be ensured before carrying out the job. Gas test shall be carried out before issuing hot work permit and the work area must be free from hydrocarbon. Executor shall ensure that all vehicles entering inside battery area have a CCE approved spark arrestor on exhaust. Vehicle shall move on designated route only. Executor must know the nearest Fire Alarm point, Fire Order, Fire Station phone number (_________), First-Aid center phone no. (_______), nearest safety shower, Escape route & location of designated assembly points and siren code before start of work. Executor shall ensure the quality of hand tools and their health. Ensure valve cap on cylinders during storage and transportation, if shrouds are not provided.

18.
1. 2. 3. 4. 5. 6. 7.

Don’ts:
Never stand or work under suspended loads. Never enter work area without safety helmet and safety shoe. Do not wear loose/ synthetic cloths while on work. Do not use short cuts on work Do not use lamp of more than 24 V while working in confined space. Do not use electrode holders as cable connectors for extension of welding cable. Never keep acetylene cylinders in horizontal condition, even if they are empty. Never use grinder without wheel guard on abrasive wheels.

8.

Recipient

RECEIVER

ISSUER 5

ISMS STANDARD – 1006

Signature Name Date
ANNEXURE-2B

__________ REFINERY DO’S AND DON’TS FOR ENTRY INTO CONFINED SPACE ( Attach with all “ Entry into vessel” Permit)
Permit No.

DO’S : 1. 2. 3. 4. 5. Check for valid work permit “Entry into Confined Space” before entry into confined space. Ensure that the confined space is positively isolated from your source of energy and has been made free from harmful gases. Proper ventilation and illumination of space must be ensured. Wherever forced ventilation is used. The gas test should be carried out after minimum 10 minutes of stopping the eductor / fan / blower. Thorough gas test must be carried out before issuing permit to ensure that there is no pocket of gas available inside and the place is safe for performing the particular task inside confined space. For entry of person the concentration of toxic gases should not exceed TLV and oxygen must be minimum 19.5 % by volume. Use suitable respiratory protection for entry in the confined space, having oxygen deficiency or having toxic gases more than TLV. Attendant should be available all the times at man way entry of confined space, till the work is in progress inside. The permit should be available with him and he shall maintain attendance in prescribed form (Annexure-2D ). Attendant must be in constant touch with persons working inside and know the actions to be taken for rescue / emergency handling, if so required. The low voltage light limited to 24 V should be allowed inside confined space. All electric connection shall be provided with ELCB. Wherever possible lifelines with safety harness should be used for entry into confined space. Special precautions are required for entry into inert gas atmosphere. It requires the controlled condition inside confined space as well as mandatory use of compressed breathing air supply to person going inside with alternate air supply arrangement. Keep at least 2 access / exit for each confined space, wherever possible. The access should be unobstructed, approachable and free from all emergency use. Use required PPE and personal gas monitors while entering inside. Use of Safety helmet and safety shoe is mandatory for all work areas. Use air mask for areas, where there is likelihood of accumulation of gas during the work such as in severs, OWS line etc.

6. 7.

8. 9. 10. 11.

12. 13.

ISMS STANDARD – 1006

6

The person in confined space should pass the warning signal to stand by person in case of any suffocation/ difficulty for help. 15. Carry out regular gas test of confined spaces, where there is possibility of gas generation due to nature of work, being performed inside such as removal of sludge, hot works etc. DON’TS Do not use light of more than 24 V inside confined space. 1. 2. Do not give any other responsibility to stand by person, which may cause his absence at man way. 3. Do not obstruct the man ways from any side of confined space.

14.

( Signature of receiver )

(Signature of Issuer )

ISMS STANDARD – 1006

7

ANNEXURE-2C Format No.-IOCL/Name of Refinery//CS/02 Sl. No. PRE ENTRY CHECKLIST FOR ………. CONFINED SPACE (To be filled up and complied before each entry into confined space. The compliance shall be followed by ‘Confined space entry permit’) ……….Refinery Associated Permit : Hot Work/ Vehicle entry Permit Confined Space Entry Permit Radiography Permit Electrical isolation/ Energisation Permit Cold Work Permit Excavation Permit Working at height permit

A. Exact location of work: (Unit/ Area/ Equipment No.)………………………………………………………………………… ……………………………………………………………………………………………………………………………………….. B. Description of work:……………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………… C. Expected date and time of entry………………………………… Expected date of completion………………………. D. Maximum No. of entrants allowed : E. Name of trained attendant for entry (Training validity 1 years)

S.N. 1. 3. S.N. 1. 3. 5. 7. 9. 11. 13. 15

Name

Trained on

S.N. 2. 4. S.N. 2. 4. 6. 8. 10. 12. 14. 16.

Name

Trained on

F. Name of trained entrants for entry (Training validity 1 years)

Name

Trained on

Name

Trained on

G. Communication facility provided and procedure established :

Yes (must be “yes” only) To be done To be done To be done Not required

Yes (must be “yes” only) I. All electrical equipment is of intrinsically safe/ FLP type Done j. Safety signs, boards and barriers are available: Done I. Debriefing and key point tipping to authorized entrants Done
H. Rescue Procedure established: Name and designation of Permittee / Entry engineer:

Signature with date

J. Checklist to be filled up by permit issuer (GSI) :

1

S.N. I. 1.

Item ENERGY ISOLATION Pumps or lines blinded, disconnected or blocked Positive isolation of electrical source, with LOTO. Other sources such as air, water, steam, gas blinded, disconnected or blocked. VENTILATION Mechanical ( must be air eductor or FLP type for inflammables)

Required

Not required

Done

S.N V.* 1.

Item PPE Full Body harness with life line provided. SCBA / air line available at site Retrieval equipment available at site. Dust respirator provided Protective clothing, hand gloves, foot wear, safety helmet, ear protection Eye / face protection Hoisting equipment

Required

Not required

Done

2.

2.

3.

3.

II. 1.*

4. 5.

2. III.

Natural ventilation only 6. Portable gas tester checked VI.* X X for healthiness IV. Continuous gas monitoring VII.* Resuscitator-inhilator required K. Gas testing reading after opening of man way : 1.Flammable……………..% LEL 2. Oxygen…………% by volume 3. H2S…………. PPM 4. CO…………………. PPM 5. Any other gas………………PPM Note : Check-list marked with * shall be complied by the executer. L. Subsequent gas tests after preparation of equipment: (To be continued till the equipment is safe for entry) Date Time Flammable (%LEL) Oxygen (% by volume) H2S in PPM CO in PPM Any (5% LEL or less) (Min. 19.5%) (Max.10 PPM) (Max. 50 PPM) other gas (in PPM)

The control measures and precautions appropriate for the safe entry and execution of the work in the confined space have been implemented and the persons required to work in the confined space have been advised of and understand the requirements . ISSUER ( Person in Direct Control) RECEIVER/ENTRY ENGINEER (Person/ Contractor Supervisor working in confined space)

Date…………………..Time ………………. Signature: Name…………………..Designation………..

Date…………………..Time ………………. Signature: Name…………………..Designation………..

*- Points shall be complied by entry engineer/ receiver and checked by issuer. Note : 1. Pre entry confined space checklist shall be used before every Confined space entry permit. 2. No confined space permit shall be issued, till the requirements of checklist are complied.

2

ANNEXURE-2D Format No.-IOCL/Name of Refinery//CS/03

ATTENDANCE SHEET FOR PERSONS INSIDE CONFINED SPACE
(To be maintained by Attendant at man way of confined space) Date: Equipment No………………… Confined space permit no………… Valid up to…………. S. N. Name of person entering Date of Entry Time of Entry in Hrs. Time of Exit in Hrs. (mention date, if changed) Sign of Attendant

NOTE: 1. This attendant sheet shall be filled and maintained at man way of confined space by stand by person for all entries in confined space. 2. This will be an integral part of permit system. E-I-C shall ensure that the stand by person has been imparted training for the job and he knows the job. He should remain in touch with persons inside during the job.

3

ANNEXURE-2E

Format No.-IOCL/Name of Refinery//CS/04 Sl No.: INDIAN OIL CORPORATION LTD.

__________ REFINERY CONFINED SPACE BOX-UP CLEARANCE
(Required only for boxing up of those confined spaces, where entry permit has been obtained for carrying out the work) Boxing up clearance from: Hrs. of Date________ __________ Hrs. of date_________ To__________

Issued to (Department/ Section/ contractor)………………………………………………………….. Location of work (Area/ Unit/ Equipment No. etc.) ………………………………………………….. All the work in above confined space has been completed and equipment may be checked for boxing up. Sign. Of Permittee _________________ THE FOLLOWING ITEMS SHALL BE CHECKED BEFORE ISSUING THE CLEARANCE (To be checked with valid permit for confined space)
Sr no 1. Item Done Not Reqd. Sr no. 6. Item Done Not Reqd

Equipment / Work Area inspected

2.

3.

4.

Surrounding area checked, cleaned and covered Space is free from all unwanted materials such as scraps/ debris, surplus items, left over tools & tackles and combustible materials. Space is free from all combustible material.

7

8.

Illumination and ventilation has been removed in my presence after checking and manhole cover has been engaged. The safety sign for “safe entry” has been removed from man way Danger sign to caution all against entry has been displayed at man way.

9 .Additional precaution if any:………………………… ……………………………… …………………

5.

Space is free from all persons

4

Gas Safety Inspector (GSI) Signature _________________________ Name ____________________________ Desig. ____________________________ Tel No. ___________________________

Permittee/ Receiver Signature ____________________________ Name _______________________________ Desig. _______________________________ Tel No. ______________________________

COMPLETION OF WORK

The boxing up of equipment has been done safely. Area at man way is cleared of all unwanted materials and freely accessible.

Permittee/ Receiver Signature ____________________________ Name ____________________________ Desig. ____________________________ The equipment has been checked; the boxing up of equipment has been done. The equipment/ area is free from all unwanted materials and freely approachable for safe operation of equipment.

GSI Signature ____________________________ Name ____________________________ Desig. ____________________________ NOTE : 1. This clearance is required for boxing up of only those confined spaces, where the permit for entry into confined space has been obtained for carrying out the hot work. 2. The boxing up clearance for equipment shall be applied by site engineer in duplicate and issued by GSI after checking. While checking inside confined space, GSI shall have a valid permit for entry as per procedure. After completion of work original copy of clearance shall be returned to issue. Duplicate copy shall be retained by site engineer. 3. The close clearances shall be retained by issuer.

5

ANNEXURE-3 Format No. IOCL/Name of Refinery/EW/01 INDIAN OIL CORPORATION LTD. Sl No.: Permit Registration No.: __________ REFINERY

EXCAVATION PERMIT

Registered by____ _____ (Sign)

Name____________________ (This permit is to be issued by area inDate_______ charge and registered at Fire Station) SHUTDOWN CONSTRUCTION Please tick the type PERMIT NORMAL of permit required TYPE 1.A. Asset custodian Dept……………………………… Date ……….………. 1B. Exact Location of Excavation In Plant Area Across Road/Footpath …………………………………………………….………… ……………………(Attach marked up drawing) Tank Dyke Along Pipe way Along Cable way Across Drainage Flume Others

In Open Ground

1C. Size of Excavation (Approx)

…………… M deep, ………….m wide ……………m long

1D. Purpose :…………………………………………………………………………………………. 2A. Commencing Date. ……………Time ….…. Expiry Date………………………Time……….. 2B. Executing Dept……………………………….. Contractor……………………………………. 2C Name of permittee with Design………………..…. Signature …………………….T.No…….. 3. Permission is granted as described above : 3A. Excavation Clearance is obtained and attached 4. Associated permits/ Safety Requirements: Cold Work Permit Hot Work Permit Confined space permit (Depth >1.2 m) Regt. No……………..

Hand Excavation Provide warning sign Provide flashing light (FLP in case of Only hazardous area) Barricade Provide shoring Batter the sides to 45 degree or less Provide Fire Provide means of Excavated soil 1 m min. away from Extinguisher access edge Body harness/ lifeline Gumboot/ safety suit Any other (specify):………………………. Expected residual hazards 1………………………………… 2………………………………… Mechanical excavation allowed only for Permit Issuer (GSI) Name & Design..……………… HOD of issuing Dept. for road cutting Name and Design……………………… DGM of issuing Dept. for dyke cutting Name and Design.……………………… Signature………………….. Date………. Signature………………….. Date………. Signature………………….. Date……….

6

5. Excavation Renewal (shift wise) Renewed up to Requested by Date Hours (Name & sign) Additional precautions, if any GSI signature Permittee (Name & sign)

6. Excavation closure : Excavation site restored to normal / safe condition

Backfilled Yes No No Reasphalted/repaired with concrete Yes No No Remarks : Executer/ Permittee Name…………………………… Signature………………….. Date………. Agree that excavation restored to our satisfaction. Remarks : GSI /FPS Name……………………………………… Signature………………….. Date……….
Note : • • • • • • The permit must be obtained one day in advance. Keep the Excavation clearance attached with permit. Permit must be available at site all the time during the work. Permit shall be in triplicate. Original in pink color shall be for permittee, first copy (white) for issuer and second copy (green) for Fire Station. The permit shall be issued normally for a period not exceeding 7 days with renewal in each shift. However for shut down units/ facilities, it can be issued for a maximum period of 15 days with renewal in each shift and for construction activities a maximum period of 30 days. The PPE such as Safety Helmet, Safety shoe, boiler suit and hand gloves is mandatory for work. Daily Safety tool box talk including key point tipping to contractor personnel shall be carried out by permittee before commencement of work and the record of same shall be maintained.

Yes Properly compacted Yes Facilities/ supports restored Yes

7

ANNEXURE-3A

__________ REFINERY
DO’S AND DON’T’S DURING EXCAVATION WORK (Attach with all Excavation permit)
Permit No.

DO’S: 1. Ensure that clearance has been obtained from various dept. in prescribed form for all excavation works. 2. Ensure that Excavation Permit and clearance has been obtained for excavation work and the same is valid. 3. All excavations and open trenches must be barricaded around the opening. Warning lamp can be used for operating area and roads during darkness (use FLP type fixture in hazardous area). 4. There must be sufficient and safe means of access and escape for excavated sites. 5. Excavation area should be free from fumes/ gases heavier than air because it may cause asphyxiation or poisoning. All excavation of depth more than 1.2 M or more should be treated as Confined space and permit for entry into confined space should be obtained. 6. Excavation to a depth of 1 M or more shall be cut stepped back to give a suitable slope or securely held by bracing so as to avoid the danger of side to collapse. 7. All trenches 1.2 M or more in depth shall at all times be equipped with at least one ladder for each 100 feet length of excavation or fraction thereof. All such ladders shall be extended from bottom of the trench to at least 1 M above the surface of the ground. 8. Barricading of 1M height (with red & white band/ self glowing caution boards) should be carried out for excavation beyond 1.5 M depth. 9. All cutting shall be carried out from top to bottom. 10. Special precautions are required for using mechanical excavators inside refinery as it requires Hot work permit to operate the same in operating areas of refinery (except on roads). 11. Practice to giving permission to cut half road and utilizing half road for movement of vehicle should be avoided, unless the conditions mentioned in Sl.–4 (Don’ts ) is complied. 12. Use suitable PPE as per job requirement mentioned in work permit. 13. Inform all incidents to your supervisor and Fire station immediately. DON’T’S: 1. Under no circumstances under cutting to be carried out. 2. Excavated earth shall not be dumped within 1 M of the edge of the excavation or depth the trench whichever is more. 3. Excavated earth should not be dumped on nearby pathway/ approaches, on product/ steam line, in front of emergency facilities such as Fire hydrants/ monitor, Fire Alarm points, Inlet of foam pourers etc. and on OWS man hole covers. 4. No vehicle should be allowed to go too close to the edge of the excavation because it may cause side collapse. Maintain at least 2 M distances from the edge of the excavation. Adequate and wellanchored stop blocks should be provided on the surface to vehicle being driven reversed into the excavation. 5. No mechanical excavation is to be carried out up to a depth of 1.5 M from the ground level in operating areas. In such cases manual excavation is required to be carried out up to a depth of 1.5 M from the ground level. 6. No one should be allowed to move on edge of excavation. (Signature of receiver) (Signature of issuer) 8

ANNEXURE-3B Format No. IOCL /Name of the Refinery/EW/02 INDIAN OIL CORPORATION LTD. Sl No.: Registration No.: __________ REFINERY EXCAVATION CLEARANCE (THIS IS NOT AN EXCAVATION PERMIT) Previous permit registration No (if any). Registered by __________ (Sign) Name____________________ Date_______

Exact Location of work (Area/ Unit/ Equipment No. etc.)……………………………………………… Description of work ……………………………………………………………………………………….. Sketch of the area of excavation enclosed. Permission is solicited from ……….Hrs. on (date)………………..to………………Hrs. on (date)……….. Signature of Executer………………………. Name and Designation of executor…………………… ___________________________________________________________________________ 1. Underground Power Cable: Existing Not existing Permission given: Yes No Precaution, if any……………………………………………………………………………………… Signature …………………….. Date ……………………… Area: DMEL/SELE/ELE ____________________________________________________________________________ 2. Underground Telecommunication Cable: Existing Not existing Permission given: Yes No Precaution, if any………………………………………………………………………………………. Signature ………………….. Date ……………Area: DMEL/SELE/ ELE (Tele Com) ____________________________________________________________________________ 3. Underground Firewater Line: Existing Not existing Permission given: Yes No Precaution, if any………………………………………………………………………………………. Signature …………………….. Date ………………Area: DMFS/SFSO/FSO ____________________________________________________________________________ 4. Underground Oil/Sewer Line, Drinking Water line, Above Ground Open Drain: Existing Not existing Permission given: Yes No Precaution, if any………………………………………………………………………………………. Signature …………………….. Date ………………Area: DMCL/SCLE/CLE ____________________________________________________________________________

9

5. Underground Computer Cable: Existing Not existing Permission given: Yes No Precaution, if any………………………………………………………………………………………. Signature …………………….. Date ……………………… Area: DMIS/SMISO/MISO ____________________________________________________________________________ 6. Underground Product Line, Utility Line: Existing Not existing Permission given: Yes No Precaution, if any…………………………………………………………………………………… Signature …………………….. Date ……………………… Area: GSI ____________________________________________________________________________ 7. Underground Instrument Cable: Existing Not existing permission given: Yes No Precaution, if any……………………………………………………………………………………… Signature …………………….. Date ………………… Area: DMIT/SITE/ITE ____________________________________________________________________________ 8. Underground Cathodic Protection Cable : Existing Not existing permission given: Yes No Precaution, if any…………………………………………………………………………………………. Signature …………………….. Date …………………Area: DMIP/SIPE/IPE ____________________________________________________________________________ INSTRUCTION : 1. The excavation clearance is required for all excavations including road and dyke cutting. Obtaining this clearance is prerequisite for EXCAVATION PERMIT. 2. This clearance shall be obtained for a maximum period of 15 days, except at construction sites, non-operational areas, where it shall be for a maximum period of 1 month. 3. This clearance shall be kept attached with Excavation permit at site. 4. The clearance shall be issued in triplicate, original (pink) for permittee, first copy (white) for issuer and second copy (yellow) for Fire station. The clearance shall be initiated by executer. 5. On issue, original copy will be with executor, duplicate copy with Fire Station and triplicate copy with area in-charge / GSI (Gas Safety Inspector). 6. The clearance by area in-charge/ GSI shall be given just before clearance by shift FSO and registration at Fire Station. At last shift FSO will also check that clearances from all other dept. have been received. 7. This clearance shall be considered issued after registration at Fire Station. 8. When job is completed, the receiver shall collect all the copies, and enclose them with closed copy of Excavation Permit before handing over to permit issuer. Permit issuer in turn after closing the permit will return the same to Fire Station.

10

9. For cutting of road in addition to this clearance, format for Road Closure and Excavation permit shall be required. The Road Closure Format shall be filled and submitted to Fire Station by the executor at least one day before starting the work.. 10. All road cuttings shall be properly barricaded with precautionary signs and alternate routes shall be displayed at the site by the executor. 11. Duly signed “Dos and Don’ts during excavation work” shall be integral part of excavation permit. All points mentioned in “Dos and Don’ts “ must be complied at site.

11

ANNEXURE-3C Format No. IOCL/Name of Refinery/EW/03

INDIAN OIL CORPORATION LTD. __________ REFINERY FORMAT FOR ROAD CLOSURE
1A. Exact Location of road blockade …………………………………………………….………… ……………………(Attach marked up drawing)

1B. Purpose :…………………………………………………………………………………………. 1C. Commencing Date. ………………………. Date of completion………………………………. 1D. Executing Dept……………………………….. Contractor……………………………………. 1E. Permit for the job to be executed has been obtained: Yes No

1F Name of executor ……………………………. Signature ………………………….T. No…….. 2. Permitted with following precautions:

2A. Name of Issuer (GSI)……………………………. Signature …………………….T.No………… 3. Permission is granted as described above with following safety precautions: Display of Speed limit Display other safety signs Display of safety sign Shift Officer of F&S Dept. Name………………………… Use traffic cone & barricading tape Mark alternate route

Display red light during night (FLP type in hazardous area) Any other requirement (Specify) ………………………………….. Signature………………….. Date……….

Important Notes:
1. Permission for road blockade should be obtained in duplicate. Original (in pink colour) shall be with executer and duplicate (white in colour) at Fire station. 2. The permission shall be obtained at least one day before commencement of work. 3. The information about road blockade shall be sent by HOD (F&S) to Area in-charge, RSM/SRSM, HOD of affected facilities, HOD (A&W)/ HOD (HR), DGM (PN), DGM (P&U), DGM (MN), GM (T) and to other concerned officers in prescribed format. 4. Duly filled and signed format must reach to Fire station one day before the commencement of job during general shift hours. 5. Provision of road blockade, diversion of traffic, display of safety signs etc. as per procedure shall be arranged by executor with consent of shift officer (F&S).

12

ANNEXURE-3D Format No. IOCL/Name of Refinery/EW/04

INDIAN OIL CORPORATION LTD. __________ REFINERY FORMAT FOR INFORMATION ABOUT MAIN ROAD CLOSURE
From : HOD (F&S) Your Ref: A. Road closure permission given for Road No. B. Location of Road C. Duration of closure D. Alternate route Sketch of road to be cut and alternate route: From……………………….to…………..………… To : Area in-charges, CPNM, CPUM, CM (A&W), executor Date of issue:

Note : 1. All drivers, using the route shall be advised to exercise caution and use alternate route by their controlling departments. 2. This information can be circulated through mail. Signature of HOD (F&S) CC : SRM/SRSM Concerned HODs Concerned DGMs GM (T) – For information please 13 Date

ANNEXURE-4
Format No.: IOCL/**/EI/01 India Oil Corporation Ltd. (Refineries Division) ________ REFINERY (OFFICE COPY) PART-III Sr. No.:
ELECTRICAL ISOLATION / ENERGISATION PERMIT - HT

Format No.: IOCL / ** / EI / 01 India Oil Corporation Ltd. PART-II (Refineries Division) Sr. No.: ________ REFINERY ELECTRICAL ISOLATION / ENERGISATION PERMIT - HT Re-Energise Clearance Certificate For HT Equipment [To be filled by Operation-In-Charge of working area] Unit Equipment Tag No. Ordinary Dat Date

Format No.: IOCL/**/EI/01 India Oil Corporation Ltd. PART-I (Refineries Division) Sr. No.: ________ REFINERY ELECTRICAL ISOLATION / ENERGISATION PERMIT - HT De-Energise Clearance Certificate For HT Equipment [To be filled by Operation-In-Charge of working area] Unit Date Equipment Tag No. Equipment not in operation Ordinary

[To be filled by Operation-In-Charge of working area on receipt of job completion certificate – PART – I & II]

Requirement: Emergency

All Locks & Tags removed

Equipment Earthing Found Intact All Clearances Returned with Job Completion Certificates

Requirement: Emergency

Unit

LOTO operation performed on “Local Switch”
Kindly de-energise the above equipment.

Equipment Tag No.

All tools, equipments, manpower and unused materials have been removed and surrounding area of the said equipment has been cleaned. Kindly energise the above equipment. Date : Name : (Signature)

Date : Time:

Name

: (Signature)

De-energized On

Time :

Designation :

Designation:

JOB COMPLETION CERTIFICATE [To be filled by Authorised Person of Electrical Operation] Date & Time
The equipment is energised after performing following Checks / Activities: YES 1. 2. Damaged internals of Breaker / MCC rectified Temporary safety ground/s removed IR Value of Cable / Equipment Checked-found O.K. Back lid / cover of Breaker boxed up All LOTO of isolating device removed Control fuse put back in place Power fuse put back in place Breaker control plug put back on its base Breaker checked in test position & found O.K. NO N/A

JOB COMPLETION CERTIFICATE [To be filled by Authorised Person of Electrical Operation]
The equipment is de-energised after performing following Checks / Activities: Isolation device is in SS No. and it’s ID YES 1. 2. 3. 4. 5. 6. 7. 8. 9.
10.

Name

NO

N/A

Signature

Equipment not in operation All back feeding circuits isolated Control supply switched off Space heater supply switched off Breaker/MCC put off & front opened Breaker racked out Control fuse pulled out Power fuse pulled out Back lid of Breaker panel opened
Breaker / MCC internals visually checked

3. 4. 5.

Energized On

6. 7. 8.

Date & Time

9.

10. Trip circuit found healthy

Name

11. Breaker racked in to service position 12. Control supply switched on

11. Line discharged & Voltage test done 12. Temporary safety ground provided 13. Breaker/ MCC back/front lids closed 14. LOTO performed on Breaker / MCC Date: Time: Name : (Signature)

Designation

13. Space heater supply switched on 14. Breaker / MCC Module front door closed

Signature Please see INSTRUCTIONS overleaf.

15. MCC [MCC Module] switched on Date : Time : Name : (Signature)

Designation :

Designation:

1

ANNEXURE-4
INSTRUCTIONS 1. This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by two vertical perforations. The PART-I is for de-energisation, the PART-II is for re-energisation and PART-III is office copy to be retained by the department of Operation-In-Charge. This Clearance certificate shall be issued in duplicate. (White and Pink copies). Both the copies to be given to Electrical Operation. On completion of the job Authorised Person of Electrical Operation shall sign on both the copies of this certificate and shall return the original white copy to the section of Operation-InCharge. Electrical Operation shall retain the second pink copy. For any equipment, the de-energising and re-energising clearance certificates shall bear the same serial numbers. The check boxes shall be ticked only to mark the selection. The issuing department of this clearance certificate should be informed immediately after de-energising / re-energising the equipment. However, permission for any activity on the isolated equipment shall be granted by the Operation-In-Charge only after Authorised Person of Electrical Operation returns the original certifying job completion. Switching off and isolation of space heater circuit shall be mandatory along with de-energisation of a motor unless specifically requested in writing by Electrical Maintenance to keep it ON. After ensuring that spring is not in charged condition and damaged internals of Breaker is rectified, rack in the breaker and put the local / remote switch in remote position. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “XXX / ZZZZ / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.
8. 1.

INSTRUCTIONS
This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by two vertical perforations. The PART-I is for de-energisation, the PART-II is for re-energisation and PART-III is office copy to be retained by the department of Operation-In-Charge. This Clearance certificate shall be issued in duplicate. (White and Pink copies). Both the copies to be given to Electrical Operation. On completion of the job Authorised Person of Electrical Operation shall sign on both the copies of this certificate and shall return the original white copy to the section of Operation-In-Charge. Electrical Operation shall retain the second pink copy. For any equipment, the de-energising and re-energising clearance certificates shall bear the same serial numbers. The check boxes shall be ticked only to mark the selection. The issuing department of this clearance certificate should be informed immediately after de-energising / re-energising the equipment. However, permission for any activity on the isolated equipment shall be granted by the Operation-InCharge only after Authorised Person of Electrical Operation returns the original certifying job completion. Switching off and isolation of space heater circuit shall be mandatory along with de-energisation of a motor unless specifically requested in writing by Electrical Maintenance to keep it ON. Any damage observed by visual checking of Breaker / Switch internals shall be informed to Electrical Maintenance through Authorised Officer of Electrical Operation. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “XXX / ZZZZ / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.

2.

2.

3.

8.

4.

3.

5.

4.

6.

6.

7. 7.

8.

2

ANNEXURE-5
Format No.: IOCL/**/EI/02 India Oil Corporation Ltd. (Refineries Division) ________ REFINERY (OFFICE COPY) PART-III Sr. No.:
ELECTRICAL ISOLATION / ENERGISATION PERMIT - LT

India Oil Corporation Ltd. Format No.: IOCL/**/EI/02 PART-II (Refineries Division) Sr. No.: ________ REFINERY ELECTRICAL ISOLATION / ENERGISATION PERMIT - LT Re-Energise Clearance Certificate For LT Equipment [To be filled by Operation-In-Charge of working area] Equipment Tag No. Requirement: Emergency Ordinary Unit Equipment Earthing Found Intact All Clearances Returned with Job Completion Certificates Dat Date

Format No.: IOCL/**/EI/02 India Oil Corporation Ltd. PART-I (Refineries Division) Sr. No.: ________ REFINERY ELECTRICAL ISOLATION / ENERGISATION PERMIT - LT De-Energise Clearance Certificate For LT Equipment [To be filled by Operation-In-Charge of working area] Unit Date Equipment Tag No. Equipment not in operation Ordinary

[To be filled by Operation-In-Charge of working area on receipt of job completion certificate – PART – I & II]

All Locks & Tags removed

Requirement: Emergency

Unit

LOTO operation performed on “Local Switch”
Kindly de-energise the above equipment. Date : Name : (Signature)

All tools, equipments, manpower and unused materials have been removed and surrounding area of the said equipment has been cleaned. Kindly energise the above equipment. Date : Time : Name : (Signature)

Equipment Tag No.

Designation :

Time :

Designation:

De-energized On JOB COMPLETION CERTIFICATE [To be filled by Authorised Person of Electrical Operation] Date & Time
The equipment is energised after performing following Checks / Activities: YES 1. 2. Damaged internals of Breaker / MCC rectified Temporary safety ground/s removed IR Value of Cable / Equipment Checked-found O.K. Back lid of Breaker boxed up All LOTO of isolating device removed Control fuse put back in place Power fuse put back in place Breaker control plug put back on its base Breaker checked in test position & found O.K. NO N/A

JOB COMPLETION CERTIFICATE [To be filled by Authorised Person of Electrical Operation]
The equipment is de-energised after performing following Checks / Activities: Isolation device is in SS No. and it’s ID YES 1. 2. 3. 4. 5. 6. 7. 8. 9.
10.

Name

NO

N/A

Equipment not in operation All back feeding circuits isolated Control supply switched off Space heater supply switched off Breaker/MCC put off & front opened Breaker racked out Control fuse pulled out Power fuse pulled out Back lid of Breaker opened
Breaker / MCC internals visually checked

Signature

3. 4. 5. 6.

Energized On

7. 8.

Date & Time

9.

10. Trip circuit found healthy

Name

11. Breaker racked in to service position 12. Control supply switched on 13. Space heater supply switched on

11. Line discharged & Voltage test done 12. Temporary safety ground provided 13. Breaker/ MCC back/front lids closed 14. LOTO performed on Breaker / MCC Date: Time: Name : (Signature)

Designation

14. Breaker / MCC Module front door closed 15. MCC [MCC Module] switched on

Signature
Date : Name : (Signature)

Please see INSTRUCTIONS overleaf.

Time :

Designation :

Designation:

1

ANNEXURE-5
INSTRUCTIONS 1. This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by two vertical perforations. The PART-I is for de-energisation, the PART-II is for re-energisation and PART-III is office copy to be retained by the department of Operation-In-Charge. This Clearance certificate shall be issued in duplicate. (White and Pink copies). Both the copies to be given to Electrical Operation. On completion of the job Authorised Person of Electrical Operation shall sign on both the copies of this certificate and shall return the original white copy to the section of Operation-InCharge. Electrical Operation shall retain the second pink copy. For any equipment, the de-energising and re-energising clearance certificates shall bear the same serial numbers. The check boxes shall be ticked only to mark the selection. The issuing department of this clearance certificate should be informed immediately after de-energising / re-energising the equipment. However, permission for any activity on the isolated equipment shall be granted by the Operation-In-Charge only after Authorised Person of Electrical Operation returns the original certifying job completion. Switching off and isolation of space heater circuit shall be mandatory along with de-energisation of a motor unless specifically requested in writing by Electrical Maintenance to keep it ON. After ensuring that spring is not in charged condition and damaged internals of Breaker is rectified, rack in the breaker and put the local / remote switch in remote position. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “XXX / ZZZZ / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year. 8. 8. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.
1.

INSTRUCTIONS
This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by two vertical perforations. The PART-I is for de-energisation, the PART-II is for re-energisation and PART-III is office copy to be retained by the department of Operation-In-Charge. This Clearance certificate shall be issued in duplicate. (White and Pink copies). Both the copies to be given to Electrical Operation. On completion of the job Authorised Person of Electrical Operation shall sign on both the copies of this certificate and shall return the original white copy to the section of Operation-In-Charge. Electrical Operation shall retain the second pink copy.

2.

2.

3.

3.

For any equipment, the de-energising and reenergising clearance certificates shall bear the same serial numbers.
The issuing department of this clearance certificate should be informed immediately after de-energising / re-energising the equipment. However, permission for any activity on the isolated equipment shall be granted by the Operation-InCharge only after Authorised Person of Electrical Operation returns the original certifying job completion. Switching off and isolation of space heater circuit shall be mandatory along with de-energisation of a motor unless specifically requested in writing by Electrical Maintenance to keep it ON. Any damage observed by visual checking of Breaker / Switch internals shall be informed to Electrical Maintenance through Authorised Officer of Electrical Operation. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “XXX / ZZZZ / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.

4.

4.

5.

5.

6. 6.

7.

7.

2

ANNEXURE-II
Format No.: IOCL / ** / EI / 03 India Oil Corporation Ltd. PART-III (Refineries Division) Sr. No.: ________ REFINERY Power & Utility Department Permit to work on High Tension (HT) Line & Equipment RE-ENERGISATION INSTRUCTION FOR ISOLATED POWER LINE / EQUIPMENT [To be filled by Permit Issuing Authority] Job completion certificate has been received from the Requisitioner / Executor for the power line / eqipment deenergised earlier. No other job clearance has been issued on this power line / equipment. Kindly re-energise the above mentioned power line / equipment. OIC of Affected Plant / Area is in agreement with the proposal. Date : Time:
Permit Issuing Authority: OIC of Affected Plant / Area:

Format No.: IOCL / ** / EI / 03 India Oil Corporation Ltd. (Refineries Division) PART-II ________ REFINERY Sr. No.: Power & Utility Department Permit to work on High Tension (HT) Line & Equipment PERMIT TO WORK CERTIFICATE
[To be filled by Permit Issuing Authority] Permit is hereby issued to ____________________ ______, ________ & _______ [Name, Designation & Dept.] for working on ______________________ _________________from __________ & ________ [Date & Time] after proper Isolation/de-energisation of the power cable / feeder / system and ensuring safe working condition after performing Lock Out and Tag Out [LOTO] operation on Breaker / Switch. This permit is valid till the return of job completion certificate. Date: Name: Designation: (Signature)

Format No.: IOCL / ** / EI / 03 India Oil Corporation Ltd. PART-I (Refineries Division) Sr. No.: ________ REFINERY Power & Utility Department Permit to work on High Tension (HT) Line & Equipment REQUISITION FOR CLEARANCE
[To be filled by Requisitioner / Executor] Power Line / Equipment To Be Isolated_____________________ Nature Of Job ___________________________________________ Tentative Duration of Work ________________________________ Plant / Area That Will Be Affected ___________________________ Requisitioned BY [Name] __________________________________ Designation ___________________________________ Date _____________Time ________hrs._____________________ [Signature Of Requisitioner] The above-mentioned equipment / related power cable may be deenergised as requested. Signature: [Permit Issuing Authority] [OIC of Affected Plant / Area] DE-ENERGISATION CERTIFICATE [To be filled by Authorised Person of Electrical Operation] The above mentioned power cable [Feeder] / equipment is deenergised after performing following Checks / Activities: YES NO N/A 1. All back feeding circuits checked & isolated 2. 3. Control supply switched off Breaker/MCC switched off & front lid opened Breaker racked out & control plug removed All fuses pulled out and kept at proper place Back cover / lid of Breaker Panel opened Breaker / MCC internals visually checked Line discharged through Earth Rod No line voltage observed on Voltage Test

(Signature) RE-ENERGISATION CERTIFICATE [To be filled by Authorised Person of Electrical Operation]
The above mentioned power cable [Feeder] / equipment is reenergised after performing following Checks / Activities: YES NO N/A 1. Damaged internals of Breaker / MCC rectified 2. Temporary safety ground/s removed 3. IR Value of Cable/Equipment Checked-found O.K. 4. Back lid / cover of Breaker boxed up 5. All Locks & Tags of Breaker removed 6. All fuses put back in place 7. Breaker control plug put back in place 8. Breaker checked in test position & found O.K. 9. Trip circuit found healthy 10. Breaker racked in to service position 11. Control supply switched on 12. Breaker / MCC Module front door closed 13. MCC [MCC Module] switched on Date: Time: Signature : Designation: (Name)

Time:

PRE-EXECUTION CHECKUP OF ISOLATED SYSTEM [To be filled by Requisitioner / Executor] Following checkup of the isolated cable / equipment / electrical system has been done before starting the work to ensure safe working condition. YES NO N/A 1. Breaker is in racked out position 2. No line voltage observed on voltage test 3. Local safety ground provided 4. LOTO done on Breaker / MCC Module Date: Time: Name: Designation: (Signature)

4. 5.

JOB COMPLETION CERTIFICATE [To be filled by Requisitioner / Executor] This is to certify that the work related to ___________ ___________________________ has been completed / stopped due to urgent requirement. All tools, unused materials and manpower have been removed. Locally provided temporary safety ground has been removed. Locks & Tags removed from Breaker / Switch / Panel. The system is safe for charging. Date: Time: Signature : Designation: (Name)

6. 7. 8. 9.

10. Temporary safety ground provided 11. Breaker/ MCC back/front lids [covers] closed 12. LOTO performed on Breaker/MCC Module Date : Time: Signature : Designation: (Name)

Please see INSTRUCTIONS overleaf.

Please see INSTRUCTIONS overleaf.

Please see INSTRUCTIONS overleaf.

1

ANNEXURE-II -II
INSTRUCTIONS 1. This Permit To Work clearance certificate is an intra departmental protocol of Electrical Department and shall be used by Electrical Maintenance, Electrical Testing and Electrical Operation to de-energisation & re-energisation of HT lines and equipments for the purpose of maintenance / project work. This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by three vertical perforations. The PART-I is for deenergisation, the PART-II is the Permit To Work certificate and Job Completion Certificate and PART-III is for re-energisation. This Clearance certificate shall be issued in original (White) in sequence of PART-I, PART-II & PART-III. PART-II shall be issued only after PART-I is returned back to Permit Issuing Authority with endorsement of de-energisation. Similarly, PART-III shall be issued only after PART-II is returned back to Permit Issuing Authority with endorsement of job completion. PART-III shall also be returned to the Permit Issuing Authority after re-energisation and the Permit Issuing Authority shall keep all the three parts as record. While filling each part, permit type i.e. HT or LT, for power line / equipment shall be chosen carefully. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “XXX / ZZZZ / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year. The check boxes shall be ticked only to mark the selection. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.
1.

INSTRUCTIONS
This Permit To Work clearance certificate is an intra departmental protocol of Electrical Department and shall be used by Electrical Maintenance, Electrical Testing and Electrical Operation to de-energisation & re-energisation of HT lines and equipments for the purpose of maintenance / project work. This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by three vertical perforations. The PART-I is for deenergisation, the PART-II is the Permit To Work certificate and Job Completion Certificate and PART-III is for re-energisation. This Clearance certificate shall be issued in original (White) in sequence of PART-I, PARTII & PART-III. PART-II shall be issued only after PART-I is returned back to Permit Issuing Authority with endorsement of de-energisation. Similarly, PART-III shall be issued only after PART-II is returned back to Permit Issuing Authority with endorsement of job completion. PART-III shall also be returned to the Permit Issuing Authority after re-energisation and the Permit Issuing Authority shall keep all the three parts as record. While filling each part, permit type i.e. HT or LT, for power line / equipment shall be chosen carefully. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “XXX / ZZZZ / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year. The check boxes shall be ticked only to mark the selection. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.

INSTRUCTIONS 1. This Permit To Work clearance certificate is an intra departmental protocol of Electrical Department and shall be used by Electrical Maintenance, Electrical Testing and Electrical Operation to de-energisation & re-energisation of HT lines and equipments for the purpose of maintenance / project work. This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by three vertical perforations. The PART-I is for deenergisation, the PART-II is the Permit To Work certificate and Job Completion Certificate and PART-III is for re-energisation. This Clearance certificate shall be issued in original (White) in sequence of PART-I, PART-II & PART-III. PART-II shall be issued only after PARTI is returned back to Permit Issuing Authority with endorsement of de-energisation. Similarly, PARTIII shall be issued only after PART-II is returned back to Permit Issuing Authority with endorsement of job completion. PART-III shall also be returned to the Permit Issuing Authority after re-energisation and the Permit Issuing Authority shall keep all the three parts as record. While filling each part, permit type i.e. HT or LT, for power line / equipment shall be chosen carefully.

2.

2.

2.

3.

3.

3.

4.

4.

4.

5.

5.

6.

8.

5. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “xxx / zzzz / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year. 6. The check boxes shall be ticked only to mark the selection. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.

6.

7.

8.

2

ANNEXURE-6A Indian Oil Corporation Ltd. (Refineries Division) ________REFINERY Format No.: IOCL / ** / EI / 05 Sr. No.:

TRIP RESET CLEARANCE CERTIFICATE FOR HT EQUIPMENT [To be filled by Operation-In-Charge of working area] Unit Equipment Tag No.

Date

Requirement of Trip resetting: Emergency

Ordinary

Equipment tripped in running condition

Equipment tripped after starting

Kindly reset the tripped Breaker / MCC Module for running the equipment. Date ____________ Designation ____________ Signature _________________________ Time ____________ Name ___________________________________________________

JOB COMPLETION CERTIFICATE [To be filled by Authorised Person of Electrical Operation] TRIP reset of the above intimated Breaker / MCC Module has been done after performing following Checks / Activities: YES NO 1. Glowing of “TRIP” indication lamp on panel observed 2. Relay status indicator visible from out side of the Panel 3. Panel front door opened using lock defeat 4. Equipment tripped on overload 5. Equipment tripped on other reason 6. Trip reset of the Breaker / MCC Module done Remarks: Equipment tripped due to operation of ___________________________________. Please refer the problem to Electrical Maintenance for rectification.

Date: Time:

Signature

: (Name)

Designation:

1

ANNEXURE-6A

INSTRUCTIONS

1. This certificate shall comprise of one page bearing Serial Number and shall be printed on a single page. 2. This Clearance certificate shall be issued in duplicate. (1st Copy: White and 2nd Copy: Pink). Both the copies are to be given to Electrical Operation. On completion of the job Authorised Person of Electrical Operation shall sign on both the copies of this certificate and shall return the original white copy to the section of Operation-In-Charge. Electrical Operation shall retain the second pink copy as record. 3. Issuer of this clearance certificate shall record the issuance of this trip reset clearance certificate against Sr.No., Date and equipment tag no. in Log Book. 4. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.

2

ANNEXURE-7
Format No.: IOCL / ** / EI / 04 India Oil Corporation Ltd. PART-III (Refineries Division) Sr. No.: ________ REFINERY Power & Utility Department Permit to work on Low Tension (LT) Line & Equipment RE-ENERGISATION INSTRUCTION FOR ISOLATED POWER LINE / EQUIPMENT [To be filled by Permit Issuing Authority] Job completion certificate has been received from the Requisitioner / Executor for the power line / eqipment deenergised earlier. No other job clearance has been issued on this power line / equipment. Kindly re-energise the above mentioned power line / equipment. OIC of Affected Plant / Area is in agreement with the proposal. Date : Time:
Permit Issuing Authority: OIC of Affected Plant / Area:

Format No.: IOCL / ** / EI / 04 India Oil Corporation Ltd. PART-II (Refineries Division) Sr. No.: ________ REFINERY Power & Utility Department Permit to work on Low Tension (LT) Line & Equipment PERMIT TO WORK CERTIFICATE [To be filled by Permit Issuing Authority]
Permit is hereby issued to ____________________ ______, ________ & _______ [Name, Designation & Dept.] for working on ______________________ _________________from __________ & ________ [Date & Time] after proper Isolation/de-energisation of the power cable / feeder / system and ensuring safe working condition after performing Lock Out and Tag Out [LOTO] operation on Breaker / Switch. This permit is valid till the return of job completion certificate. Date: Time: Name: Designation: (Signature)

Format No.: IOCL / ** / EI / 04 India Oil Corporation Ltd. PART-I (Refineries Division) Sr. No.: ________ REFINERY Power & Utility Department Permit to work on Low Tension (LT) Line & Equipment REQUISITION FOR CLEARANCE [To be filled by Requisitioner / Executor]
Power Line / Equipment To Be Isolated_____________________ Nature Of Job ___________________________________________ Tentative Duration of Work ________________________________ Plant / Area That Will Be Affected ___________________________ Requisitioned BY [Name] __________________________________ Designation ___________________________________ Date _____________Time ________hrs._____________________ [Signature Of Requisitioner] The above-mentioned equipment / related power cable may be deenergised as requested. Signature: [Permit Issuing Authority] [OIC of Affected Plant / Area] DE-ENERGISATION CERTIFICATE

(Signature)
PRE-EXECUTION CHECKUP OF ISOLATED SYSTEM

RE-ENERGISATION CERTIFICATE [To be filled by Authorised Person of Electrical Operation]
The above mentioned power cable [Feeder] / equipment is reenergised after performing following Checks / Activities: YES NO N/A 1. Damaged internals of Breaker / MCC rectified 2. Temporary safety ground/s removed 3. IR Value of Cable/Equipment Checked-found O.K. 4. Back lid / cover of Breaker boxed up 5. All Locks & Tags of Breaker removed 6. All fuses put back in place 7. Breaker control plug put back in place 8. Breaker checked in test position & found O.K. 9. Trip circuit found healthy 10. Breaker racked in to service position 11. Control supply switched on 12. Breaker / MCC Module front door closed 13. MCC [MCC Module] switched on Date: Time: Signature : Designation: (Name)

[To be filled by Requisitioner / Executor]
Following checkup of the isolated cable / equipment / electrical system has been done before starting the work to ensure safe working condition. YES NO N/A 1. Breaker is in racked out position 2. No line voltage observed on voltage test 3. Local safety ground provided 4. LOTO done on Breaker / MCC Module Date: Time: Name: Designation: (Signature)

[To be filled by Authorised Person of Electrical Operation]
The above mentioned power cable [Feeder] / equipment is deenergised after performing following Checks / Activities: YES NO N/A 1. All back feeding circuits checked & isolated 2. 3. 4. 5. 6. 7. 8. 9. Control supply switched off Breaker/MCC switched off & front lid opened Breaker racked out & control plug removed All fuses pulled out and kept at proper place Back cover / lid of Breaker Panel opened Breaker / MCC internals visually checked Line discharged through Earth Rod No line voltage observed on Voltage Test

JOB COMPLETION CERTIFICATE

[To be filled by Requisitioner / Executor]
This is to certify that the work related to ___________ ___________________________ has been completed / stopped due to urgent requirement. All tools, unused materials and manpower have been removed. Locally provided temporary safety ground has been removed. Locks & Tags removed from Breaker / Switch / Panel. The system is safe for charging.

10. Temporary safety ground provided 11. Breaker/ MCC back/front lids [covers] closed 12. LOTO performed on Breaker/MCC Module

Date: Time:

Signature : Designation: (Name)

Date : Time:

Signature : Designation: (Name)

Please see INSTRUCTIONS overleaf.

Please see INSTRUCTIONS overleaf.

Please see INSTRUCTIONS overleaf.

1

ANNEXURE-7 -7
INSTRUCTIONS 1. This Permit To Work clearance certificate is an intra departmental protocol of Electrical Department and shall be used by Electrical Maintenance, Electrical Testing and Electrical Operation to de-energisation & re-energisation of HT lines and equipments for the purpose of maintenance / project work. This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by three vertical perforations. The PART-I is for deenergisation, the PART-II is the Permit To Work certificate and Job Completion Certificate and PART-III is for re-energisation. This Clearance certificate shall be issued in original (White) in sequence of PART-I, PART-II & PART-III. PART-II shall be issued only after PART-I is returned back to Permit Issuing Authority with endorsement of de-energisation. Similarly, PART-III shall be issued only after PART-II is returned back to Permit Issuing Authority with endorsement of job completion. PART-III shall also be returned to the Permit Issuing Authority after re-energisation and the Permit Issuing Authority shall keep all the three parts as record. While filling each part, permit type i.e. HT or LT, for power line / equipment shall be chosen carefully. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “XXX / ZZZZ / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year. The check boxes shall be ticked only to mark the selection. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.
1.

INSTRUCTIONS
This Permit To Work clearance certificate is an intra departmental protocol of Electrical Department and shall be used by Electrical Maintenance, Electrical Testing and Electrical Operation to de-energisation & re-energisation of HT lines and equipments for the purpose of maintenance / project work. This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by three vertical perforations. The PART-I is for deenergisation, the PART-II is the Permit To Work certificate and Job Completion Certificate and PART-III is for re-energisation. This Clearance certificate shall be issued in original (White) in sequence of PART-I, PARTII & PART-III. PART-II shall be issued only after PART-I is returned back to Permit Issuing Authority with endorsement of de-energisation. Similarly, PART-III shall be issued only after PART-II is returned back to Permit Issuing Authority with endorsement of job completion. PART-III shall also be returned to the Permit Issuing Authority after re-energisation and the Permit Issuing Authority shall keep all the three parts as record. While filling each part, permit type i.e. HT or LT, for power line / equipment shall be chosen carefully. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “XXX / ZZZZ / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year.

INSTRUCTIONS 1. This Permit To Work clearance certificate is an intra departmental protocol of Electrical Department and shall be used by Electrical Maintenance, Electrical Testing and Electrical Operation to de-energisation & re-energisation of HT lines and equipments for the purpose of maintenance / project work. This certificate shall comprise of three parts, bearing common Serial Number and shall be printed on a single page separated by three vertical perforations. The PART-I is for deenergisation, the PART-II is the Permit To Work certificate and Job Completion Certificate and PART-III is for re-energisation. This Clearance certificate shall be issued in original (White) in sequence of PART-I, PART-II & PART-III. PART-II shall be issued only after PARTI is returned back to Permit Issuing Authority with endorsement of de-energisation. Similarly, PARTIII shall be issued only after PART-II is returned back to Permit Issuing Authority with endorsement of job completion. PART-III shall also be returned to the Permit Issuing Authority after re-energisation and the Permit Issuing Authority shall keep all the three parts as record. While filling each part, permit type i.e. HT or LT, for power line / equipment shall be chosen carefully.

2.

2.

2.

3.

3.

3.

4.

4.

4.

5.

5.

6.

The check boxes shall be ticked only to mark the selection. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.

5. The nomenclature for Sr. No. which shall be followed and printed on the Clearance Certificate is given as under: “XXX / ZZZZ / YY” where XXX: three digit Book Number, ZZZZ: Four digit Clearance Number and YY: Last two digits of current year. 5. The check boxes shall be ticked only to mark the selection. The two stars (**) in Format No. shall be replaced with abbreviated name of the respective Refineries like HR, MR, BR, GR, DR etc. in the final print.

7.

6.

7.

6.

2

ANNEXURE-7A Indian Oil Corporation Ltd. (Refineries Division) ________REFINERY Sr. No.:

TRIP RESET CLEARANCE CERTIFICATE FOR LT EQUIPMENT [To be filled by Operation-In-Charge of working area] Unit Equipment Tag No.

Date

Requirement of Trip resetting: Emergency

Ordinary

Equipment tripped in running condition

Equipment tripped after starting

Kindly reset the tripped Breaker / MCC Module for running the equipment. Date ____________ Designation ____________ Signature _________________________ Time ____________ Name ___________________________________________________

JOB COMPLETION CERTIFICATE [To be filled by Authorised Person of Electrical Operation] TRIP reset of the above intimated Breaker / MCC Module has been done after performing following Checks / Activities: YES NO 1. Glowing of “TRIP” indication lamp on panel observed 2. Relay status indicator visible from out side of the Panel 3. Panel front door opened using lock defeat 4. Equipment tripped on overload 5. Equipment tripped on other reason 6. Trip reset of the Breaker / MCC Module done Remarks: Equipment tripped due to operation of ___________________________________. Please refer the problem to Electrical Maintenance for rectification.

Date: Time:

Signature

: (Name)

Designation:

1

ANNEXURE-7A

INSTRUCTIONS

1. This certificate shall comprise of one page bearing Serial Number and shall be printed on a single page. 2. This Clearance certificate shall be issued in duplicate. (1st Copy: White and 2nd Copy: Pink). Both the copies are to be given to Electrical Operation. On completion of the job Authorised Person of Electrical Operation shall sign on both the copies of this certificate and shall return the original white copy to the section of Operation-In-Charge. Electrical Operation shall retain the second pink copy as record. 3. Issuer of this clearance certificate shall record the issuance of this trip reset clearance certificate against Sr.No., Date and equipment tag no. in Log Book.

2

Annexure-8 Format No. IOCL/Name of Refinery/WH/01

INDIAN OIL CORPORATION LIMITED
___________ REFINERY

Sl. No.

PERMIT FOR WORKING AT HEIGHT
(REQUIRED FOR WORKING AT HEIGHTS OF 2.0 METERS & ABOVE) This permit authorizes for provision of safe access / platform/ working arrangement at height for carrying out the job. In addition depending on nature of work, separate work permit must be obtained.

FROM :

_____

HRS

DATE_________

TO ______

HRS

DATE________

NAME OF THE AGENCY / CONTRACTOR……………………………………………………………. NAME OF THE SITE SUPERVISOR…………………………………………………………………… JOB/WORK ORDER NO__________________LOCATION OF WORK ___________________ DESCRIPTION OF WORK ______________________________________________________ TOTAL NO. OF WORKERS ALLOWED __________________________________________
PERMITTEE SHALL CHECK THE FOLLOWING ITEMS FOR COMPLIANCE BEFORE SOLICITING THE PERMISSION.

YES
1. 2. 3. 4. 5. 6. Have scaffolds been checked and certified in prescribed form by scaffold supervisor? Have scaffolds been tagged with green card duly filled and signed by scaffold supervisor? Is scaffold rechecked and re-certified weekly? Is scaffold erected on firm ground and sole plate & base plate have been used? Is the hanging baskets used of proper construction, tested and certified for the purpose. Is the work platform made free of hazards of all traps/ trips/ slips & fall? Have cat ladders, crawling boards etc been used for safe working at sloping roof Has edge protection provided against fall from roof/ elevated space?

NOT REQ

7. 8.

THE FOLLOWING ITEMS SHALL BE CHECKED FOR RISK ASSESMENT BY ISSUER AND COMPLIED BY PERMITTEE BEFORE SOLICITING THE PERMISSION. 9. Is the platforms been provided with Toe board, guardrail & area below is barricaded.

10. Checked whether safety harness & necessary arrangement for tying the life-line, fall arresters etc provided to the worker for working at height. 11. Have precaution been listed below for safe working at height for source of energy Such as electricity 11 Is proper means of access to the scaffold including use of standard aluminum ladder provided ? 12. Is the raised work surface properly illuminated? 13. Is the workers are working near unguarded shafts, excavations or hot line? 14. Checked for provision of collective fall protection such as safety net

1

15. Additional PPE recommended ____________________________________________________________________________ ADDITIONAL PRECAUTION REQUIRED, IF ANY ____________________________________________________________________________ ____________________________________________________________________________ Fire Permit Signatory /Gas Safety Inspector (Issuer) Permittee/ Receiver

Signature __________________________ Signature _______________________________ Name _____________________________ Name ___________________________________ Desig. ______________ Tel No. ________ Desig. ___________________ Tel No. ________ Concerned Area HOD/RSM ** Signature & Date _____________________ Permittee HOD ** Signature & Date ____________________

** Required in case: Permit is needed beyond normal working hours (8.00 Hrs to 17.00 Hrs.)/ round the clock/ Sundays & holidays. Closing of the work permit: Receiver : Certified that the subject work has been completed / stopped and area cleared Issuer: Verified that the job has been completed and area cleared and is safe from any hazard.

Date & Time

Name & Designation

Signature

Date & Time

Name & Designation

Signature

Clearance Renewal: Additional Time Date precautions From To if any, Name of GSI / Otherwise FPS mention “NIL”

Issuer Desig. of GSI / FPS

Receiver Signature Name of Desig. of Permittee of GSI / Permittee FPS Signature of Permittee

2

INSTUCTIONS: 1. This permit will be issued in Triplicate. GREEN COPY (ORIGINAL) and WHITE COPY (TRIPLICATE) will be for the Permittee. ISSUING AUTHORITY will retain WHITE COPY (DUPLICATE). This permit shall be valid for a period of 8 hours only, unless it is renewed/ extended. This clearance on the same permit can be renewed/ extended up to a maximum of seven calendar days. 2. After the completion of the job, copies of work permit should be returned to the ISSUER. 3. Items applicable must be ticked (√). 4. All works at height shall be discontinued during rain/ high wind/ floods. 5. Stop all jobs in case scaffold is sagging unduly. Report to EIC. 6. Metallic tubular scaffolding and standard aluminium ladders are only to be used. 7. All works must stop on instruction from permit issuing authority, permittee and officers of F&S Dept. or whenever unsafe condition is detected. 8. Permittee shall obtain permission from the respective disciplines. 9. Permittee to ensure the compliance of safety precaution required mentioned in permit 10. Use of approved type full body safety harness along with lifeline is must for working at height of 2.0 M and above. 11. Permit must be available at site during the work. 12. Use of safety helmet and shoe is mandatory for all work sites. 13. Permittee shall ensure that all working personnel have taken SAFETY TRAINING before start of work. Toolbox talk and key point tipping shall be given by permittee daily before start of work. 14. Sketches should be provided, if required. 15. Term “TRAP” means a gap of 1 inch or more in scaffold platform, “TRIP” means projected object on floor of work platform such as overlap of scaffold boards etc., “SLIP” means oily/ slippery floor of scaffold platform and “FALL” means Fall prevention measures such as guard rail/ toe guard is in place.

3

ANNEXURE-8A Format No. IOCL/Name of Refinery/WH/03

PRE ERECTION CHECKLIST FOR SCAFFOLDS
(To be filled up and complied before erection of scaffold at site, before giving permit to start the erection)

Sl. No. ……….

..….Refinery Type of scaffold to be erected : Independent scaffold Independent tied scaffold Mobile scaffold Quick fix scaffold Birdcage scaffold Truss scaffold System scaffold Slung scaffold Drop scaffold Any other (specify)…………
A. Exact location of work: (Unit/ Area/ Equipment No.)………………………………………………………………………… ……………………………………………………………………………………………………………………………………….. B. Description of work to be performed…………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………… C. Expected date and time to start erection………………………………… Expected date of completion………………… D. Maximum No. of persons allowed on scaffold after erection :

E. Associated Permit : Hot Work / Entry into Confined Space Permit Cold Work Permit Confined Space Entry Permit Radiography Permit Excavation Permit Electrical isolation/ Energisation Permit Working at height Permit F. For the scaffold sufficient quantity of materials are available at site: S. Items Yes No Not S.N. Items Yes No Not N Required Required 1. Scaffold pipes* 2. Scaffold couplers * X X 3. Deck boards* 4. Base plate* X 5. Sole plate 6. Toe board# 7. Reveal pin 8. Standard aluminum ladder (as per IS/ BS)# 9. Mettle Wire to fix 10. Tags (RED & X ladder # GREEN)* 11. Toe board clip # 12. Joint pin 12. Approved full 13. Double fork type body safety lanyard with energy harness with absorber## lanyard/ life line ** 14. Fall arrester 15. Safety Net
*- Compulsory for all scaffolds, used for working at height by persons. # Compulsory for scaffold of height 1.8 M and above. ## Compulsory during scaffold erection, repair, modification & dismantling and also when ladder is not in use. ** Compulsory for 2 M and above.

4

S. N. 1. 3. 5. 7. 9.

Name

Trained on

S.N. 2. 4. 6. 8. 10.

Name

Trained on

G. Name of trained scaffold supervisor (Training validity- 1 years) : 1…………………………..…2…………………………….

H. Quality of scaffold materials available at site: S.N. Items Yes No 1. Are scaffold tubes not damaged/ deformed? * 3. 5. Is couplers suitable type and free from defects? Are standard metal wires available for tying ladder?

S.N. Items 2. Are scaffold boards / sole plates damaged/deformed? ** 4. Are base plates free from defects? 6. Are Standard alluminium ladder (s) free from defects, deformity and temporary repairs.
Signature with date

Yes

No

*- Refer drawing no. **- Refer drawing no. Name and designation of site engineer / E-I-C:

I. Safety check by issuer :

S.N. 1.

Items Area inspected for erection of scaffold and found surface consolidated/ hardened Are other PPE such as fall arrester available? Is 100% safety briefing given by Site engineer before start of work? Are warning signs, barricading tapes available at site?

Yes No

Not S.N. Items Required 2. Is safety harness (s) with lanyards available and in good condition?

Yes No

Not Required

X X

3.

4.

Is Safety net available? Are scaffold materials properly stacked at site, without obstruction approach routs? Is medical certificate for persons working at a height of 2M and above available?

5.

6.

7.

7.

ISSUER (GSI)

RECEIVER/EXECUTER (Site engineer)

5

Date…………………..Time ………………. Signature: Name…………………..Designation………..

Date…………………..Time ………………. Signature: Name…………………..Designation………..

IMPORTANT NOTES: -This pre erection checklist shall be filled up by executer and issuer before start erection of each scaffold. -Pre-erection checklist shall be filled by E-I-C in duplicate and submit to issuer for further check. On further check by issuer, the executer shall comply with all requirements as mentioned in checklist and sign the checklist. - Duplicate copy shall be returned to issuer after compliance, whereas original shall be retained by executer. -Check-list points marked as “NO” must be attended and addressed in this format.

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ANNEXURE-8B Format No. IOCL/Name of Refinery/SS/02

REFINERY
CHECK LIST FOR SCAFFOLD
UNIT LOCATION/ EQUIPMENT DATE/ INSPECTED TYPE OF SCAFFOLD ERECTERED BY

Item Foundation Standards

Ledgers

Transoms Bracing Ties Fittings Ladders

Guardrails Toe-boards Others General Comments

Checkpoint Firm and even Vertical Staggered joints Right spacing Not damaged Level Staggered joints Not loose Not damaged Right spacing Not loose Right support None missing Not loose Right fitting Not damaged Check couplers Proper angle Right length Properly secured Separate landing Right extension Right height Right length None missing

Condition

Comments

Action

Contractor’s Supervisor/ Engineer Name Signature Date & Time

Maintenance Engineer/ Civil/ Mechanical/ Inst. Engr.

Contractor shall carry out further periodic inspections every seven days. Above signatories must approve any change made to the scaffold after signing this check list.

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ANNEXURE-8C
Format No. IOCL/Name of Refinery/WH/04

MEDICAL CERTIFICATE Form for Medical Check Up for the Workman engaged by the Contractor (Working at Heights) Certified that I ___________________ have examined Shri ____________________Age _________ who has signed below in my presence. The details of his examination as required are given in the enclosed medical examination report. I certify that all clinical and pathological tests were done in my hospital/dispensary under my instructions and I find him fit. General and physical examinations of Shri ________________ do not reveal any abnormality. He does not suffer from any acute / chronic skin disease or any contagious or infectious disease. He is medically fit to work at height of 2.0 meters and more since he is free from Vertigo, Epilepsy or Fits, general giddiness and height related disease. His B.P., Pulse, Eye sight etc. are normal. In my opinion Shri ____________________ is physically and mentally fit for job in _____________ _______________________ Signature of the workmen Date: _____________________________ Signature and Rubber stamp of medical practitioner with name Note: This certificate is to be given on the letter head of the registered medical practitioner who is possessing allopathic qualification as recognized by the Indian medical council. Below the signature, the rubber stamp of the medical practitioner should be affixed. Te letterhead normally should contain the following: 1) Name of the Medical practitioner: 2) Qualifications: 3) Registration Number: 4) Designation: 4) Address:

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ANNEXURE-9 Format No. IOCL/Name of Refinery/RP/01 INDIAN OIL CORPORATION LTD. Sl No.: __________ REFINERY RADIATION PERMIT (This permit is to be issued by area in-charge and registered at Fire Station) Valid from : _________Hrs Date_______ To __________ Hrs Date________

Permission is granted to Dept./ Section/ contractor ……………………………………………….. Name of radiography agency ……………………………………………………………………….. Name of site supervisor (Level-2 holder) ………………………………………………………….. Specific Location of work ……………………………………………………………………………. Name, Design & Signature of Permittee…………………………………… Part-1 (TO BE FILLED BY RADIOGRAPHY AGENCY) RADIATION SOURCE Type of Radiation : X-Ray Gama Ray Ir-192/ Co-60

No. of Source:_________________ Radiation Activity (Intensity) :

_____________ Kv/ Ci

MEASUREMENT OF CONTROL ON RADIATION EXPOSURE • • • • • • • Collimater: Radiation Survey Meter: Film Badge: Concrete Wall Barrier: Pocket Dosimeter: Alarm/ Lamp : Yes Yes Yes Yes_____mr/ hr Yes Yes No No No No No No Not Required Not Required Not Required

Cordon off Distance:___________ in Meters. Others :_______________________

No. of Persons involving in Radiation Work :___________________ Radiography site in charge Name / Signature of officer (Insp. Dept.) _______________________ Name/ Signature :_______________________________ IOCL, Refinery Registration No. of agency:

1

THE FOLLOWING ITEMS SHALL BE CHECKED BEFORE ISSUING THE PERMIT BY ISSUER Part-2 (Please put tick [√ ] mark in the appropriate box) Item Done Not Item Done Not Req. Req. 1. Equipment/ work Area 4. Proper lighting inspected. provided. 2. Associated permit taken for the job (specify the types and permit no.). Area cordoned off (in case of radiography) with proper symbol. 5. Radiation survey meter available at site.

3.

1. Following additional PPE to be used in addition to standards PPE (Helmet, Safety Shoes, Hand gloves, Boiler suit) (Tick the relevant items): Face Shield Goggles Dust Respirator Fresh Air Mask Lifeline Safety Harness Compressed Air Set Earmuff Film badge/ dosimeter Others

2. Additional precaution, if any__________________________________________________________________ ________________________________________________________________________ HOD/RSM ( In case of working GSI/ FPS Permittee/ Receiver beyond office hours) Signature Signature Signature ___________________________ _________________________ ___________________ Name Name ___________________ Name _________________________ Desig. ___________________ __________________ Desig. ________ Tel No.______ Tel No. ________ Desig.______________ Tel No. ______ SPECIAL INSTRUCTIONS 1. This permit shall be valid for a period of 8 hours only, unless it is renewed/ extended. This clearance on the same permit can be renewed / extended up to a maximum of seven calendar days. In case of fire alarm all work must immediately be stopped. In case of Emergency Sirens, all work must be stopped and all nonessential personnel must leave work site and processed to designated areas. This permit must be available at work site at all times. This permit is to be made in duplicate: Blue & white colour. Blue copy is issued to Permittee/ Executor. The White copy is to be retained by issuing authority. 2

2.

3. 4.

On completion of job, area to be cleared and copies of permit to be returned to the issuer after closing of permit. The same shall be closed by issuer and kept as record. 6. All the columns in the form should be filled properly. No column should be left blank. 7. Announcement to be made and removal of nonessential persons are to be ensured from condoned off area before commencement of job. The barricading is to be done with warning tape with display of Radiation hazard symbol at site by the site radiographer after carrying out the radiation survey. 8. The radiography should preferably be carried out at a time, when occupancy is least. 9. Radiation source movement within the site is to be maintained as per BARC norms. 10. The supervisor must be available at site during the radiography work. 11. “Level-2 holder” means “Radiological Safety Officer” designated by the employer and who in the opinion of the competent authority is qualified to discharge the functions under Rule-13 of The Gazette of India No.-44, Oct’30, 1971. 12. The distance for barricading is decided by RSO depending upon on strength of radiation source, occupancy factor and radiation work load. Closing of the work permit: Receiver : Certified that the subject work has been completed / stopped and area cleared Issuer: Verified that the job has been completed and area cleared and is safe from any hazard.

5.

Date & Time

Name & Designation

Signature

Date & Time

Name & Designation

Signature

Clearance Renewal: Time Date From To Additional precautions if any, Otherwise mention “NIL” Issuer Name and Desig. of GSI / FPS Signature of GSI / FPS Receiver Name Signature Signature of and of RSM (In case Desig. of Permittee of work Permittee beyond normal working hrs.)

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ACCIDENT BRINGS TEARS, SAFETY BRINGS CHEERS

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