Hydro / Flushing Permit

HYDRO / FLUSHING TEST Permit Permit No.:

(LOTO PERMIT TO BE ATTACHED IF ISOLATIONS ARE REQUIRED) ( HSE Sign):

SECTION 1 - Specification of Work (Filled by Supervisor )

Area Start Time
Location Start Date
Permit Finish Time
Job Performer Finish Date
Contractor Department
Phone Schematic Drawings & Diagrams * Yes * No
Pressure utilized Method statements * Yes * No
SECTION 2 - Performance of Work (Filled by Supervisor )
SAFETY RELATED CHECKS

Nr. ITEM TO CHECK CHECK POINT YES NO N/A Nr. ITEM TO CHECK YES NO N/A

1 DRAIN VALVES LOCKED IS THERE ANY SOURCE OF ELECTRICITY (E.g.)

POWER PANEL ETC.) EXITS WITHIN THE HYDRO
2 DRAIN VALVES TAPPED 13
TEST EFFECTED AREA.IF YES, ENSURE CONTROLS
3 BRANCH LINE CONNECTED IN CASE OF LEAKAGE.
4 BRANCH LINE TAPPED IS THERE ANY FLOOR OPENING / EXPANSSION
5 MAIN VALVES LOCKED 14 JOINT IN THE HYDRO TEST AREA. IF YES, ENSURE
CONTROLS IN CASE OF LEAKGAE.
6 BRANCH VALVES LOCKED
7 BRANCH VALVES TAPPED IS HYDRO TEST BEING CONDUCTED ABOVE
SUBSTATION. IF YES, DID YOU CHECK IF ANY
8 SEISMIC EXP JOINT NO DAMAGE 15
CHANCE OR OPENING ON THE WATER PROOFING
9 THERMAL EXP JOINT NO DAMAGE OF SUBSTATION ROOF?
10 FILLING POINT FIXED PROPERLY IS THE AREABARRICATED AND SIGNAGE PLACED
16
11 PRESSURING POINT FIXED PROPERLY (EXCLUSION ZONE)
12 DRAIN POINT FIXED PROPERLY 17 IS AIR LEAK TEST DONE BEFORE HYDRO TEST
Comments:

SECTION 3 - Permit Approval (Filled by Supervisor ) must be signed before work commence
I accepted this permit, agree to be bound by the conditions detailed above and the associated procedures, and accept responsibility as the person directly in charge of the work. I have read the Activity Method Statement & Risk
Assessment and Procedure, prepared the 4C and communicated it to my crew, and have observed the risk control in place.
Permit Requestor (PR) Date
Signature
(Activity Engineer or Supervisor ) Time
SECTION 4 - AREA AUTHORITIES (AA) APPROVAL
I confirm that conditions relating to this permit remain unchanged ad valid as long as the work site conditions remains the same. I declare that all information given in this permit is true and correct

AFET ENGINEER MAIN CONTRACTOR / MEP MAIN CONTRACTOR / AREA CONSTRUCTION MANAGER
Print / Sign: Print / Sign: Print / Sign:
Date: Date: Date:
SECTION 5 - ISSUING AUTHORITY (IA)- HSE DEPARTMENT must be signed before work commence
I have checked that the work requirements and precautions have been identified by the Permit Requestor (PR) and authorize the work to proceed.
Date: to: Date:
Approved start of work Time: to: Time:
NAME IA: Signature
SECTION 6 - COMMITMENT (JOB PERFORMER) must be signed before work commence
I declared that all requirements are in place and all required test are done. (If required) before work commence.
PERMIT REQUESTOR / SUPERVISOR FOREMEN / CHARGEHAND
Sign: Date: Sign: Date:
SECTION 7 - DAILY PERMIT REVALIDATION
I declared that all requirements are in place and all required test are done. (If required) before work commence.
1st Day 2nd Day 3rd Day 4th Day 5th Day 6th Day 7th Day
NAME
Supervisor
AFET Engineer
HSE Officer
SECTION 8 - COMPLETION / SUSPENSION OR CANCELLATION of WORK
All work associated with this Hydro Test Permit has been: COMPLETED * CANCELLED * SUSPENDED *
The work area and adjacent areas have been inspected after completion of the work and all hazards have been made safe: * YES * NO
Additional Comments:

AFET ENGINEER: Signature: Date of Completion: Time:

Note: Lockout / Tagout Log sheet to be attached if isolations are required (F365)

AFET-IMS-F255 | HSE | Permit – Hydro / Flushing| Issue 1 | Rev 0 | Jun '17