HSE-F-007

PAK-ARAB PIPELINE COMPANY LIMITED Rev.# 5 Rev. Date 18.02.2020

PIPELINE DIVISION (Ref: Doc. No. HSE-SOP-007)

Work Site RADIOGRAPHY PERMIT No.

This Permits Section/Dept:
To carryout radiography:

Type of Radiation Equipment to be used: Strength of source:

Location of work: Field work:
Shifts Morning Evening Night
Date
VALIDITY PERIOD
From
Time
To
EQUIMENT TO BE USED (tick) Radiation Source,
B - SAFETY EQUIPMENT &
A - ACTIONS & CONDITIONS LIST Yes No N.A Mark
CLOTHING REQUIRED
ORIGINATING AUTHORITY

Are Radiation Safety Signs located? Film Badges

Are Fire Equipments Available? Goggles / Face Shield
Is Non-IS Equipment used? Dosimeter
Is one sounding Radiation Detector provided? Gas Mask / Dust Mask
Is work area Barricaded for Controlled area of 0.75 milli Holding Tong
rem /hr OR 7.5 micro Sv / hr? Other:
In case of field work Information to Security provided
Any Job Associated Hazards / Residual Hazards ( Yes / No ) if yes, Details:……………………………………………………………………
…………………………………………………………………………………………………………………………………………………………….
C – GAS TESTING Required Not Required
Material to be tested LEL O2 H2 S CO Gas testing conducted by
Safe Limits % >19.5 % 10 ppm 50 ppm Name P.NO Time Meter #
Test results Morning shift
Test results Evening shift
Test results Night shift
Special Instruction
To do follow up job on site: Shift Incharge Ops Engr. Station Incharge A.O / S.O
I certify that I have inspected the site and it is safe for work to start. Shift Morning Evening Night
Originating
Authority

I have not inspected the site but acknowledge the work Name
Operation Engineer/ Station Incharge P. No
Signature: ___________________. P. No: _____________
Sign
D – AUTHORIZED USER'S CHECKS YES NO NA
Is the Isotopic Retractor is in good working condition?
Is the Camera holding the Isotope good for that source strength and leak proof?
Is the Radiographer capable of returning the source to the Camera, if the source pencil has
Fallen, Misplaced or Damaged?
All the protective clothing is available?
Is Radiation Emergency Handling Procedure available on the site?
ACCEPTING
AUTHORITY

Is Area Cordoned Off and Stand-By Persons detailed to prevent others approach?
Is a Survey Meter available for detecting Radiation limits?
E – AUTHORIZED USER'S CHECKS Shift Morning Evening Night
Authority
Accepting

I fully understand the Job Conditions, Hazards and Residual Hazards that Name
can be encountered during the job and discussed with the Performing
P. No
staff.
Performer's sign. ………………………………P. No. .…………...……. Sign
F - COMPLETION Work Completed Housekeeping Done
Cold work stopped Permit canceled
Reason to stop or cancel the permit………………………………………………………………………………………………
Accepting Authority Sign. ………………….. Originating Authority sign.…………….....… Date ………..…… Time .….…..…

S.No Type of Permit S # of Permit Date of Issue S.No Date of Issue S # of Permit Date of Issue
1 4
 2 5

TI 3 6
E-
IN
PE