Work Permit Version:

Permit No. :
07/2015
........................................... 
Additional excavation work requirements
The location of all underground pipelines, electrical-, water- and other lines have thoroughly been examined
Status

Oiltanking Matola, SA
Permit Issuer: ...........................................  If applicable, the contractor was briefed on the type and depth of present underground lines
Date & Time: ...........................................
 The exact location of the excavation has been marked (attach plan with exact location marked)
Authorized Permit Applicant
 A manual pre-excavation down to a depth of ....................... (m) is required for safety reasons
Department: Name:
…………………........................................................................ …………………..…………………….……………….………..................
 A hot work permit is required as contaminated soil and/or groundwater is expected to be encountered
Planned Work Additional working at height requirements
Description of work: ................................................................................................. .................................................................................................................................................................................. Additional protection equipment:
Location of work: .................................................................................................................................................................................................... (add sheet for map, if required)  Temporary handrail  Mobile scaffolding  Fixed scaffolding  Cherry picker
Equipment to work on: ..............................................................................................................................................................................................................................................................................  Raised platform  Safety net  Safety harness  Others ..................................................
Equipment to be used: ..............................................................................................................................................................................................................................................................................  All fall protection equipment is certified and checked to be used correctly
Vehicle types to be used: ..............................................................................................................................................................................................................................................................................  Life jackets have to be worn when working over water
Expected period of work: From ............................................ (date) ............................. (hrs) to ............................................ (date) ............................ (hrs)  No piles of material higher than 1.2 m are stored at workplaces above 2 m height
Performing company: ………………………………….…………………...……………….. Number of people: ............................................................................................................  Scaffolding has been adequately erected at proper location (attach respective scaffolding certificate)
This Permit is applicable for the following Additional radiation work requirements

 Hot work  Cold work  Confined space entry  Vehicle entry  All radiation sources and equipment are approved and licensed by the applicable regulatory authorities

 Electrical work  Excavation work  Working at height  Radiation work  The radiation work will be carried out by licensed radiation worker

General Safety Checks

 The radiation outside the barricaded area will be below the maximum permissible levels

In case of an emergency the control room must be informed immediately by terminal telephone (???) or VHF. A field check has to be  The work site has been marked with the applicable signs for radiation
carried out to fill in the status of the requirements. Special instructions (use additional sheets if required):
 All contractors have received an HSSE induction and understood its content
 Job-based risk assessment must be carried out (attached to permit), document no. : ……………………………………. The following safety and fire fighting equipment must be provided or activated at the work site:
 Contractor have been briefed on the fluids contained in the neighbouring equipment  Powder extinguisher  CO2 extinguisher  Firehose/ branchpipe  Firewatch (name: …...……….…… )
 Pressure relief valves have been vented to safe areas  Foam car  Fire fighting truck  Fixed fire monitor  Others ..................................................
 Contractor have been provided with a terminal radio or other means of communication for emergency situations Personal Protective Equipment
 Operations department has been informed about the works planned Minimum PPE in the restricted area are helmet, antistatic/product resistant safety shoes & antistatic clothing covering arms/legs.
Permit Requirements The following additional protective equipment is required:
A field check has to be carried out to fill in the status of the requirements. Status  Safety glasses  Protective gloves  Dust respirator  LEL / O2 meter with alarm
General cold and hot work requirements  Safety goggles  Overall  Mask with filter  Personal H2S detector
 Work site has been barricaded, adequately marked and does not block emergency exits and equipment or escape routes  Face shield  Chemical protective suit  S. C. breathing apparatus  Life jacket
 Welding must be conducted by approved welder who holds valid welder’s pass for welding process and joint type to be applied
 Ear protection  Rubber safety boots  Safety harness / line  Others ..................................................
 Equipment must be de-pressurised/flushed/drained/purged, checked for leakage and is free of hazardous material
Gas-free Certificate
 Electrical equipment must be locked out / tagged out, LOTO tag No.: …..……….............…… Regular gas tests considering the wind direction shall be carried out by an Authorised Gas Tester and recorded on this form.
 Immediate work site must be cleared from combustible materials, spark/flash screens/barriers have to be placed  Because of the more complex situation a separate Gas-free Certificate is required (attach to permit).
 All related pipe work must be physically isolated by  disconnecting  blind-plating Time: ……………... h Signature ……………... h Signature ……………... h Signature The equipment/vessel/work site (15 m range) has been gas tested by
 All nearby (at least 15 m range) vents, drains, sample points, sewers, pits and other openings have to be sealed Gas (% LEL) an Approved Gas Tester and certified gas-free.
 Ventilation is needed  natural  mechanical O2 (%) No. of serial gas tester:............................................................
 Equipment to work on must be earthed H2S (ppm) Date: ..................................................... Time: ......................................................................

Additional confined space entry requirements Name: ...................................................... Signed: ......................................................................

 The confined space/vessel did contain the following hazardous material: ......................................................................................
Permit Aproval & Validity
 A vessel entry control board has been provided to identify and monitor movement of vessel entry personnel Permit is valid (for one shift only) when complete by authorised Oiltanking personnel and signed. The validity must be extended if
work is allowed to be continued after expiring. The permit is automatically suspended due to an emergency or changes in work site
 A rescue plan is available and a trained stand-by person (name …………………………. )has been assigned for the duration of the work conditions making it unsafe to continue the work. The work can only be resumed upon clearance from the approving authority.
Additional vehicle entry requirements Authorised Permit Issuer Authorised Permit Receiver
 Driver (name:…………………………………………..…….) of vehicle (licence plate:……………………………..….………) has a valid driving licence I confirm that the work site was inspected and all necessary measures I accept the permit and confirm that work will be carried out safely
 The vehicle must be fitted with a spark arrestor have been taken to ensure the work is carried out safely. subject to fulfilment of the permit conditions and requirements.

 Roads have to be closed (attach plan with exact location marked and closure time indicated)
Date: ..................................................... Time: ….......................................................... Date: ..................................................... Time: …..........................................................

Name: ..................................................... Sign: Name: ..................................................... Sign:

 The movement of heavy vehicles must be guided
….......................................................... …..........................................................

Permit & Work Status

 The route and the surrounding area is free of product and product vapour
The permit must be returned for extension, in case of cancellation, after suspension or completion of the work.
 The entry route to the work site/tank pit has been determined Permit Work
 The driver is aware of the maximum height of the determined route
 The work has been suspended.
Authorized Permit Receiver:
 The driver is aware of the speed limit on the terminal  The permit has been cancelled.
Name: ..................................................... Sign: …..........................................................

Date: ..................................................... Time:


…..........................................................
Additional electrical work requirements The work has been completed and the permit is herewith invalid.
Authorized Permit Issuer:
 The electrical work will be carried out by licensed electricians (Work site has been cleared, cleaned, equipment has been returned.)
Date: ..................................................... Time: …..........................................................
 The equipment to work on has been de-energised and electrically disconnected in the substation Date: ..................................................... Time: …..........................................................
Name: ..................................................... Sign: …..........................................................

 All switches have been properly marked with warning signs All rights reserved. This document was prepared to control safety relevant work on Oiltanking facilities only. No warranty is made, either expressed or implied.