Ser.

No: continued from permit Associated Excavn/Entry #

44580
Work Order
ACTIVE ‫ﺍﻟﺸﺮﻛﺔ ﺍﻟﻜﻮﻳﺘﻴﺔ ﻟﻠﺼﻨﺎﻋﺎﺕ ﺍﻟﺒﺘﺮﻭﻟﻴﺔ ﺍﻟﻤﺘﻜﺎﻣﻠﺔ‬

KUWAIT INTEGRATED PETROLEUM INDUSTRIES COMPANY

Technical Authority ‫ﺗﺼﺮﻳﺢ ﻋﻤﻞ ﺳﺎﺧﻦ‬
Type:
OPERATIONS Hot Work Permit

1.(A) Exact Location 1- (‫ﺃ(ﺍﻟﻤﻮﻗﻊ ﺍﻟﻔﻌﻠﻲ‬

FIRE HYDRANT HQ-02018 NORTH SIDE OF B03 ( ‫ﺇﻟﺦ‬... / ‫ ﻣﻌﺪﺓ‬/ ‫ ﻭﺣﺪﺓ‬/ ‫) ﻣﻨﻄﻘﺔ‬

UNIT-98-02 - FIREWATER / FIREWATER DISTRIBUTION SYSTEM

ZOR - Al-Zor Refinery Project

(B) Description of Work (attach sketch if required) (‫) ﺏ( ﻭﺻﻒ ﺍﻟﻌﻤﻞ ( ﺍﺭﻓﻖ ﻣﺨﻄﻄﺎﹰ ﺇﺫﺍ ﻟﺰﻡ ﺍﻷﻣﺮ‬
INTERLOCK BLOCK PAVING REMOVE AND MANUAL EXCAVATION FOR EXPORT OF PIPIE

Using HANDTOOLS , POWER TOOLS ‫ﺑﺎﺳﺘﺨﺪﺍﻡ‬

GENERATOR 79161
(mention tools/equipment & Safety Cert. No. if applicable) ( ‫ ﺍﻟﻤﻌﺪﺍﺕ ﻭﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺴﻼﻣﺔ ﺇﻥ‬/ ‫ﺍﺫﻛﺮ ﺍﻷﺩﻭﺍﺕ‬
‫)ﻭﺟﺪﺕ‬
(C) Issued to Major Projects Al-Zour Refinery / Major Projects IV / GW / (‫ﺝ( ﺻﺎﺩﺭ ﺇﻟﻰ‬
JV OF HYUNDAI E&C.LTD(LEADER),SAIPEM SPA.AND
Issuer Tel. 96527
SK E&C CO. Executor Tel. 65837919
Dept./ Div./ Craft/Contractor ‫ ﺍﻟﻤﻘﺎﻭﻝ‬/‫ ﺣﺮﻓﺔ‬/‫ ﺍﻟﻘﺴﻢ‬/ ‫ﺍﻟﺪﺍﺋﺮﺓ‬

2. Work is Critical Yes No 2- ‫ﻫﻞ ﺍﻟﻌﻤﻞ ﺧﻄﺮ‬

Work Permit Risk Assessment done & attached

Yes Not Required ‫ﻫﻞ ﺗﻢ ﻋﻤﻞ ﺗﻘﻴﻴﻢ ﻟﻠﻤﺨﺎﻃﺮ ﻭﺇﺭﻓﺎﻗﻪ‬

Fire Station / EDC informed

Yes Not Required ‫ ﻣﺮﻛﺰ ﺇﺭﺳﺎﻝ‬/ ‫ﻫﻞ ﺗﻢ ﺇﺑﻼﻍ ﻣﺮﻛﺰ ﺍﻹﻃﻔﺎء‬
‫ﺍﻟﻄﻮﺍﺭﺉ‬
Issuer & Executor jointly checked work site
Yes Not Required ‫ﻫﻞ ﻗﺎﻡ ﺍﻟﻤﺼﺪﺭ ﻭﺍﻟﻤﻨﻔﺬ ﺑﻔﺤﺺ ﻣﻮﻗﻊ ﺍﻟﻌﻤﻞ ﻣﻌﺎﹰ‬

3 - ‫)ﻣﺘﻄﻠﺒﺎﺕ ﺍﻟﺴﻼﻣﺔ )ﻳﻠﺰﻡ ﺍﺳﺘﺨﺪﺍﻡ ﺧﻮﺫﺓ ﻭﻧﻈﺎﺭﺍﺕ ﻭﺣﺬﺍء ﺍﻟﺴﻼﻣﺔ‬

3. Safety Requirement (USE OF SAFETY HELMETS, SPECTACLES AND BOOTS IS MANDATORY)
(‫ﺃ( ﻫﻞ ﺗﻢ ﻟﻠﻤﻌﺪﺓ ؟‬ (‫ﺏ( ﺍﻟﻤﺨﺎﻃﺮ ﺍﻟﻤﺤﻴﻄﺔ ﻭﺍﻟﻤﺘﻮﻗﻌﺔ‬ (‫ﺝ( ﺇﺟﺮﺍءﺍﺕ ﺍﻟﻮﻗﺎﻳﺔ‬
Y NR (A) Has the equipment been? Y N (B) Expected residual hazards Y NR (C) Protection measures
‫ﻋﺰﻝ ﻣﻦ ﺍﻟﺴﺎﺋﻞ ﺃﻭ ﺍﻟﻐﺎﺯﺍﺕ‬ ‫ﺃﻭ ﺳﺎﺋﻞ ﻗﺎﺑﻞ ﻟﻼﺷﺘﻌﺎﻝ‬/‫ﻏﺎﺯ ﻭ‬ ‫)ﻗﻔﺎﺯﺍﺕ) ﺣﺪﺩ ﺍﻟﻨﻮﻉ‬
Isolated from liquid or gases- Combustible gas &/or liquid- Gloves (type)-
‫ ﻣﻊ‬،‫ﺍﻵﻟﺔ ﻣﺰﻭﺩﺓ ﺑﻤﺎﻧﻊ ﺍﻟﺸﺮﺭ‬ Other ‫ ﻣﻀﻐﻮﻃﺔ‬/‫ﺧﺮﻃﻮﻡ ﻣﻴﺎﻩ ﺟﺎﺭﻳﺔ‬
‫ﺷﻬﺎﺩﺓ ﺳﻼﻣﺔ ﺻﺎﻟﺤﺔ‬ ‫ﺁﺧﺮ‬- Running / Pressurised water hose-
Engine with exhaust spark arrester & valid ‫ﻧﻘﺺ ﺍﻷﻛﺴﺠﻴﻦ‬ ‫ ﺗﺮﺑﻠﻴﻦ‬/ ‫ﺗﺴﻮﻳﺮ ﺍﻟﻤﻮﻗﻊ ﺑﺸﺮﻳﻂ‬
safety cert- Lack of O2- ‫ﻣﻘﺎﻭﻡ ﻟﻼﺣﺘﺮﺍﻕ‬
‫ ﺃﻭ ﺗﺼﺮﻳﻒ ﻟﻠﺴﻮﺍﺋﻞ‬/ ‫ﺗﺼﺮﻳﻒ ﻟﻠﻀﻐﻂ ﻭ‬ ‫ ﻏﺎﺯﺍﺕ ﺳﺎﻣﺔ‬/ ‫ﻛﺒﺮﻳﺘﻴﺪ ﺍﻟﻬﻴﺪﺭﻭﺟﻴﻦ‬ Barricade with flame retardant Tarpaulin /
Depressurised &/or drained- H2S/Toxic gases- Tape-
‫ ﻓﺼﻞ‬/ ‫ﺗﻢ ﺍﺳﺘﺨﺪﺍﻡ ﺻﻔﻴﺤﺔ ﻋﺰﻝ‬/ ‫ﻋﺰﻝ‬ ‫ﻣﻮﺍﺩ ﻛﻴﻤﻴﺎﺋﻴﺔ ﺁﻛﻠﺔ‬ ‫ ﻭﺍﻗﻴﺎﺕ ﺍﻷﺫﻥ‬/ ‫ﺳﺪﺍﺩﺍﺕ‬
Blanked/ Blinded/ Disconnected- Corrosive chemicals- Ear plug / Muff-
‫ ﺗﻄﻬﻴﺮ‬/ ‫ﻏﺴﻴﻞ‬ ‫ ﻗﺸﻮﺭ‬/ ‫ﺣﺪﻳﺪ ﺗﻠﻘﺎﺋﻲ ﺍﻻﺷﺘﻌﺎﻝ‬ ‫ ﻭﺍﻗﻲ ﺍﻟﻮﺟﻪ‬/ ‫ﻭﺍﻗﻴﺎﺕ ﺍﻟﻌﻴﻨﻴﻦ‬
Flushed / Purged- Pyrophoric iron / Scales- Goggles /Face shield-
‫ ﻣﻴﻜﺎﻧﻴﻜﻴﺔ‬/ ‫) ﺗﻬﻮﻳﺔ ) ﻃﺒﻴﻌﻴﺔ‬ ‫ ﻛﻬﺮﺑﺎء ﺍﺳﺘﺎﺗﻴﻜﻴﺔ‬/ ‫ﻛﻬﺮﺑﺎء‬ ‫ﻣﻼﺑﺲ ﻭﺍﻗﻴﺔ‬
Ventilated (natural/mechanical)- Electricity / Static- Protective clothing-
‫ﺗﻐﻄﻴﺔ ﺍﻟﺒﺎﻟﻮﻋﺎﺕ ﻭﻣﺠﺎﺭﻱ ﺍﻟﺼﺮﻑ‬ ‫ ﺛﻠﺞ‬/ ‫ ﺑﺨﺎﺭ‬/ ‫ﺣﺮﺍﺭﺓ‬ ‫ ﻗﻨﺎﻉ ﻣﺘﺼﻞ‬/ ‫ ﻏﺎﺯ‬/ ‫ﻗﻨﺎﻉ ﻏﺒﺎﺭ‬
Sewers & drains covered- Heat/ Steam / Frost- ‫ﺑﺨﺮﻃﻮﻡ ﻫﻮﺍء‬
‫ﺇﺯﺍﻟﺔ ﺍﻟﻤﻮﺍﺩ ﺍﻟﻘﺎﺑﻠﺔ ﻟﻼﺣﺘﺮﺍﻕ ﻣﻦ‬ Dust / Gas / Airline mask-
‫ﺭﻃﻮﺑﺔ ﻋﺎﻟﻴﺔ‬
‫ﺍﻟﻤﻨﻄﻘﺔ‬ High humidity- ‫ﻋﺪﺓ ﺍﻟﺴﻼﻣﺔ ﻭﺣﺒﻞ ﺇﻧﻘﺎﺫ‬
Combustibles removed from area- Safety harness & lifeline-
‫ﺇﺷﻌﺎﻉ ﻣﺘﺄﻳﻦ‬
‫ﺍﻧﺴﻴﺎﺏ ﻣﺴﺘﻤﺮ ﻟﻠﻐﺎﺯ ﺍﻟﺨﺎﻣﻞ‬ Ionizing radiation- ‫ ﻭﺻﻞ ﺍﻟﻤﻌﺪﺍﺕ‬/ ‫ﺗﻮﺻﻴﻞ ﺃﺭﺿﻲ‬
Cont. inert gas flow arranged- Eqpt. grounded/bonded-
‫)ﻣﻮﺍﻓﻘﺔ ﻗﺴﻢ ﺍﻟﺘﻔﺘﻴﺶ )ﺍﻧﻈﺮ ﺃﺩﻧﺎﻩ‬ ‫ﺧﺮﻃﻮﻡ ﺍﻟﻤﺎء‬/‫ﻃﻔﺎﻳﺔ ﺣﺮﻳﻖ‬
Approved by Inspection (see below)- Fire extinguisher/ Water hose-
‫ﻣﺮﺍﻗﺐ ﺣﺮﻳﻖ‬
Fire watch-

Name of Fire Watch: / BA ‫ﺍﺳﻢ ﻣﺮﺍﻗﺐ ﺣﺎﻟﺔ ﺍﻟﺤﺮﻳﻖ ﻭﺃﺟﻬﺰﺓ ﺍﻟﺘﻨﻔﺲ‬

attendant:
Others / Details: ‫ﺗﻔﺎﺻﻴﻞ ﺃﺧﺮﻯ‬
‫ﺍﻧﻈﺮ ﺧﻠﻒ ﻫﺬﺍ ﺍﻟﺘﺼﺮﻳﺢ ﻟﻤﻌﺮﻓﺔ ﺍﻟﻤﺘﻄﻠﺒﺎﺕ ﺍﻹﺿﺎﻓﻴﺔ ﻭﺍﻟﺸﺮﻭﻁ ﺍﻷﺧﺮﻯ‬.
See the back of this permit for additional requirements and other conditions.
‫ ﻋﻤﻞ ﺗﺮﻗﻴﻊ ﻋﻠﻰ ﺧﻄﻮﻁ ﺗﺤﺖ ﺍﻟﺘﺸﻐﻴﻞ‬، ‫ ﻟﺤﺎﻡ‬، ‫ﻳﺠﺐ ﺇﺭﻓﺎﻕ ﻣﻮﺍﻓﻘﺔ ﻗﺴﻢ ﺍﻟﺘﻔﺘﻴﺶ ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻌﻤﻞ ﻋﻠﻰ ﺳﻄﺢ ﺧﺰﺍﻥ ﻣﺘﺂﻛﻞ‬.
Inspection approval paper shall be attached for hot tap, patch work on live lines and work on a corroded tank roof.

١٧٠" ‫ "ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻄﻮﺍﺭﺉ ﺍﺗﺼﻞ ﻋﻠﻰ ﻫﺎﺗﻒ ﺭﻗﻢ‬Rev.-0/March 2019

IN ANY EMERGENCY DIAL "170"
 ‫ﻓﺤﺺ ﺍﻟﺤﺪ ﺍﻷﺩﻧﻰ ﻟﻼﺷﺘﻌﺎﻝ ﺇﺟﺒﺎﺭﻱ ﻟﺠﻤﻴﻊ ﺍﻷﻋﻤﺎﻝ ﺍﻟﺴﺎﺧﻨﺔ ﺑﻤﺎ ﻓﻲ ﺫﻟﻚ ﺩﺧﻮﻝ ﺍﻟﻤﺮﻛﺒﺎﺕ ﻣﻨﻄﻘﺔ ﻣﺤﺎﻃﺔ ﺑﺎﻟﺨﻄﺮ‬
LEL TEST IS MANDATORY FOR ALL HOT WORK INCLUDING VEHICLE ENTRY IN HAZARDOUS AREA
4.(A) Gas Test Not Required (only outside operation area)‫)ﻏﻴﺮ ﻣﻄﻠﻮﺏ )ﺧﺎﺭﺝ ﻣﻨﻄﻘﺔ ﺍﻟﻌﻤﻠﻴﺎﺕ ﻓﻘﻂ‬ 4 (‫ﺃ( ﻓﺤﺺ ﺍﻟﻐﺎﺯ‬

Continuous monitoring ‫ﻣﺮﺍﻗﺒﺔ ﻣﺴﺘﻤﺮﺓ‬ Re-test every ‫ﻳﻌﺎﺩ ﺍﻟﻔﺤﺺ‬

‫ ﺳﺎﻋﺔ‬.... ‫ﻛﻞ‬

See associated Entry Authorisation ‫ﺍﻧﻈﺮ ﺗﺼﺮﻳﺢ ﺍﻟﺪﺧﻮﻝ ﺍﻟﻤﺮﻓﻖ‬

‫ﺃﻛﺴﺠﻴﻦ ﺍﻷﺩﻧﻰ ﺍﻟﻮﺭﺩﻳﺔ‬

‫ﺍﻟﺤﺪ‬ ‫ﻛﺒﺮﻳﺘﻴﺪ ﺍﻟﻬﻴﺪﺭﻭﺟﻴﻦ‬
‫ﺃﺧﺮﻯ ﺃﻛﺴﻴﺪ ﺍﻟﻜﺒﺮﻳﺖ ﺃﻭﻝ ﺃﻛﺴﻴﺪ‬
‫ﺩﺭﺟﺔ ﺍﻟﺤﺮﺍﺭﺓ ﺛﺎﻧﻲ‬
‫ﻧﺴﺒﺔ ﺍﻟﺮﻃﻮﺑﺔ‬ ‫ﻓﺎﺣﺺ ﺍﻟﻐﺎﺯ‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫ﺍﻟﻮﻗﺖ‬
‫ﺍﻟﻜﺮﺑﻮﻥ‬ Others GAS TESTERS Date Time
Shift Comb. O2 % H2S PPM CO PPM <25 SO2 PPM <2 Temp. C RH %
‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫ﺭﻗﻢ ﺍﻟﺘﻮﻇﻴﻒ‬
Name & Signature
Emp. No.

(B) Electrical Isolation )‫ﺏ( ﺍﻟﻌﺰﻝ ﺍﻟﻜﻬﺮﺑﺎﺋﻲ‬

Not Required (or N/A) ‫ﻏﻴﺮ ﻣﻄﻠﻮﺏ )ﺃﻭﻏﻴﺮ ﻗﺎﺑﻞ‬ Use Multilock ‫ﺍﺳﺘﺨﺪﻡ ﻧﻈﺎﻡ ﺍﻟﻘﻔﻞ‬
‫)ﻟﻠﺘﻄﺒﻴﻖ‬ ‫ﺍﻟﻤﺘﻌﺪﺩ‬

Use single lock ‫ﺍﺳﺘﺨﺪﻡ ﺍﻟﻘﻔﻞ ﺍﻟﻔﺮﺩﻱ‬ Use “DO NOT OPERATE” Tag ‫"ﺍﺳﺘﺨﺪﻡ ﺑﻄﺎﻗﺔ "ﻻ ﺗﺸﻐﻞ‬

(i) All electrical circuits / equipment have been isolated by: ‫ﺗﻢ ﻋﺰﻝ ﺟﻤﻴﻊ ﺍﻟﻤﻌﺪﺍﺕ ﻭﺍﻟﺪﻭﺍﺋﺮ ﺍﻟﻜﻬﺮﺑﺎﺋﻴﺔ ﺑﻮﺍﺳﻄﺔ‬: (i)
Emp. Name. ‫ ﺍﺳﻢ ﺍﻟﻤﻮﻇﻒ‬Emp. No. ‫ ﺭﻗﻢ ﺍﻟﺘﻮﻇﻴﻒ‬Designation ‫ ﺍﻟﻮﻇﻴﻔﺔ‬Signature ‫ ﺍﻟﺘﻮﻗﻴﻊ‬Tel. ‫ﻫﺎﺗﻒ‬

(ii) Multi Lock System ‫( ﻧﻈﺎﻡ ﺍﻟﻘﻔﻞ ﺍﻟﻤﺘﻌﺪﺩ‬ii)

‫ﺍﻟﻮﺭﺩﻳﺔ‬ Name / Emp. No./ Signature ‫ ﺭﻗﻢ ﺍﻟﺘﻮﻇﻴﻒ‬/ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫ﺍﻟﻮﻗﺖ‬
Shift Date Time
Electrical Maint. ‫ﺍﻟﺼﻴﺎﻧﺔ‬ Mechanical Maint. ‫ﺍﻟﺼﻴﺎﻧﺔ‬ Others ‫ﺃﺧﺮﻯ‬
‫ﺍﻟﻤﻴﻜﺎﻧﻴﻜﻴﺔ‬
‫ﺍﻟﻜﻬﺮﺑﺎﺋﻴﺔ‬
5. Authorization / Renewal (It is safe to proceed with this job) 5 ‫ ﺍﻟﺘﺠﺪﻳﺪ (ﺍﻟﻮﺿﻊ ﺁﻣﻦ ﻭﻳﻤﻜﻦ ﺍﻟﺒﺪء ﻓﻲ ﻫﺬﺍ ﺍﻟﻌﻤﻞ‬/ ‫)ﺍﻟﺘﺼﺮﻳﺢ‬

/ ‫ﺍﻟﻮﺭﺩﻳﺔ‬ Time ‫ﺍﻟﻮﻗﺖ‬ Name / Emp. No./ Signature. ‫ﺍﻟﺘﻮﻗﻴﻊ‬/ ‫ ﺭﻗﻢ ﺍﻟﺘﻮﻇﻴﻒ‬/ ‫ﺍﻻﺳﻢ‬.
‫ﺍﻟﺘﺎﺭﻳﺦ‬
Date / Shift
‫ﻣﻦ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﻤﺼﺪﺭ‬ ‫ﺍﻟﻤﻨﻔﺬ‬ ‫ﺍﻟﻤﻘﺎﻭﻝ‬ ‫ﻣﺸﻐﻞ ﺍﻟﺤﻘﻞ‬
From To Issuer Executor Contractor Field Operator
8Aug2022 M8 10:45 11:00 72919 - Sairam Kyvalyam 74168 - Trirat Phonloed - 72711 - Ashok Varma Manthena
Vankamamidi t.phonloed@kipic.com.kw a.manthena@kipic.com.kw
s.vankamamidi@kipic.com.kw 08August2022 10:48
08August2022 10:47
6. Permit Closure 6- ‫ﺇﻏﻼﻕ ﺍﻟﺘﺼﺮﻳﺢ‬
(A) Work Completed ‫ﺗﻢ ﺇﻧﺠﺎﺯﻩ‬ Stopped Will continue on N/A ‫ﺳﻮﻑ ﻳﺴﺘﻤﺮ ﻓﻲ‬ (‫ﺃ( ﺍﻟﻌﻤﻞ‬

‫ﺗﻢ ﺗﺴﻠﻴﻢ ﺍﻟﻤﻮﻗﻊ ﺑﻮﺿﻊ ﺃﻣﻦ‬ Yes No ‫ﺗﻢ ﺗﻨﻈﻴﻒ ﺍﻟﻤﻜﺎﻥ‬ Yes No
Site Handed Over in Safe Condition? Housekeeping Done?
‫ﻧﻈﺎﻡ ﺍﻷﻗﻔﺎﻝ ﺍﻟﻤﺘﻌﺪﺩ ﺃﺯﻳﻞ‬ Yes No Not Applicable
Multi Lock Removed
‫ﺍﺳﻢ ﺍﻟﻤﹹﻨﹷﻔﹽﹻﺬﹺ‬ ‫ﺭﻗﻢ ﺍﻟﺘﻮﻇﻴﻒ‬ ‫ﺍﻟﻮﻇﻴﻔﺔ‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫ﺍﻟﻮﻗﺖ‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫ﻫﺎﺗﻒ‬
Executor Name Emp. No. Designation Signature Time Date Tel.

Remarks ‫ﻣﻼﺣﻈﺎﺕ‬

(B) Agreed to above. Site was checked Yes No ( ‫ ﻭﻓﺤﺺ‬، ‫ﺏ( ﺗﻤﺖ ﺍﻟﻤﻮﺍﻓﻘﺔ ﻋﻠﻰ ﻣﺎ ﺫﻛﺮ ﺃﻋﻼﻩ‬
and found safe. ‫ﺍﻟﻤﻮﻗﻊ ﻭﻭﺟﺪ ﺁﻣﻨﹱﺎ‬
Field Operator signature/Emp. No. 71874 - Sri Sai Ram Charan Gottimukkala ‫ ﺭﻗﻢ ﺍﻟﺘﻮﻇﻴﻒ‬/ ‫ﺗﻮﻗﻴﻊ ﻣﺸﻐﻞ ﺍﻟﺤﻘﻞ‬
s.charan@kipic.com.kw
‫ﺍﺳﻢ ﺍﻟﻤﹹﺼﹿﺪﹺﺭﹺ‬ ‫ﺭﻗﻢ ﺍﻟﺘﻮﻇﻴﻒ‬ ‫ﺍﻟﻮﻇﻴﻔﺔ‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫ﺍﻟﻮﻗﺖ‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫ﻫﺎﺗﻒ‬
Issuer Name Emp No. Designation Signature Time Date Tel.