SECTION 2 (Owner Approval) Hot Tap Checklist Form A

To be completed by the Job Coordinator Prior to Welding

( ) Y ( ) N ( ) n/a Has a JSA been completed and attached to this form?

( ) Y ( ) N ( ) n/a Does the JSA address the risks associated with losing a coupon or introducing metal
shavings?

( ) Y ( ) N ( ) n/a Does the JSA denote measures taken to reduce the risk of burn through, and provide
a contingency plan in the event of burn through?

( ) Y ( ) N ( ) n/a Will radio communication with the Control Room be available during the execution of
this work?

( ) Y ( ) N ( ) n/a Has a complete Hot Tap/Stopple Document Package been provided to the Operations
Manager or designee?

( ) Y ( ) N ( ) n/a If a stopple is going to be used, does the JSA address measures to be taken if the
stopple fails?

To ensure compliance with OSHA's Lockout/Tag-out Standard under 1910.147, the hot tap must be
justified. The OSHA standard, as proposed, stipulated that hot tap operations would be exempt from the
requirements of the standard if the employer could demonstrate that: (1) Continuity of service is essential;
(2) shutdown of the system is impractical; and (3) documented procedures and special equipment are
utilized which will provide effective protection for employees.

Details of Requirement for continuity of service and/or impracticality of system shutdown:

NOTE: Operation Signatures signify that the Hop Tap location and size are correctly identified, that the risks
of performing a hot tap and the alternatives to a hot tap have been reviewed, and that performing a hot tap is
necessary.

Signatures

Operations Manager or Designee

Print Name:
Signature: Date:

Job Coordinator
Print Name:
Signature: Date:

A hot work permit CANNOT be issued if Sections 1 & 2 are not signed and/or there are any “No” answers.

CONTROLLED DOCUMENT- 24 HRS

8:37 am 12/29/2018
-- UNCONTROLLED THEREAFTER --