Glow Shipping Lines L. L. C.

COLD WORK PERMIT CHECK LIST

SHIP       DATE       SPACE      

The permit is valid only for the conditions stated below and is automatically cancelled upon the activation of any
emergency alarm.

Ship condition1 Loaded/Ballast

Work to be carried      

out

1. ISOLATION METHODS

Spading/disconnection/locked Location
valves/other

Liquid            

Gas / Vapor            

Machinery            

2. PREPARATION

2.1. Previous contents of equipment/system were Depressurised/Drained/IG Purged/Washed/Vented

2.2 Present contents of equipment/system Depressurised/Drained/IG Purged/Washed/Vented

2.3. Equipment/system has been Depressurised/Drained/IG Purged/Washed/Vented

2.4. Cargo operation have been stopped YES NO

2.6. Surrounding areas free of other hazards YES NO

which affect work

3. PROTECTIVE CLOTHING/SAFETY EQUIPMENT REQUIRED-

     

1
Delete as applicable.
Form: SF107 Rev. MAY 2015 Issued/Approved by: DPA/GM Page 1 of 2 MS – M6
 Glow Shipping Lines L. L. C.

4. SPECIAL PRECAUTIONS
1. Frequency of gas monitoring to be carried out is      
2. Other requirements     

5. AREA AUTHORISATION

Period       From       Hours       Date      

of
Validity To       Hours       Date      

I have checked the above conditions and consider it safe to carry out the work stated during the
following period provided that the conditions laid down are followed.

Signed: Ch.Eng / Ch.Officer

6. ACCEPTANCE

I understand the precautions to be taken and will return this permit for cancellation upon
completion/suspension.

Signed: Person in charge

Signed Personnel to carry out the work

7. ENTRY AUTHORITY

Permission to carry out the work stated is granted subject to the conditions above.

Signed: Master

Form: SF107 Rev. MAY 2015 Issued/Approved by: DPA/GM Page 2 of 2 MS – M6