HOT WORK PERMIT

SHIP: EXERCISE
Work to be carried out by: Ship Personnel Contractor
Location of Work BUNKER LINE ON MAIN DECK
Nature of Work CHANGING OLD BROKEN PIPE
Date: 22.08.2012
Est. Duration: 9 Hrs
Before this Permit is Authorised and Hot Work is commenced, written approval for the Hot Work
must be received from OFFICE.

Section 1. Permit to be completed by or Officer in Charge.

ALL QUESTIONS MUST BE ANSWERED Yes No Remarks Initials

1. Can this work be performed in such a way that X RR
Hot Work can be avoided?
2. The area been thoroughly cleaned and ventilated X RR
3. The area / compartment is gas free X RR
4. There sufficient oxygen for entry (20.8%) N/A OPEN RR
DECK
5. All equipment and / or compartment is free of any X RR
substance that may be ignited by work being done
6. Adjacent compartments have been check free of X RR
flammable material
7. All points where any flammable substance may X RR
enter the equipment / compartment has been
properly blanked off
8. A Fire Watch / Safety Observer has been X RR
appointed and briefed as to function
9. Fire fighting equipment has been rigged / X RR
stationed in readiness
10. Electrical circuits have been isolated when N/A OPEN RR
necessary DECK
Records of gas test to be entered in Section 3
Written approval for this Hot Work has been received from OFFICE Yes

Copy of OFFICE’s approval is attached to this Permit Yes

Section 2. Authorisation by Master

In my opinion the work shown on this Permit can be carried out safely.

Permit valid until: _____17.00____________ (maximum validity of permit is 12 hours)

Name:____________ Signed:______________________

Date: ________________ Time: ____08.00_________

QMS Amendment No. 0 Issued: 01/01/04 Page 1 of 2 QMS Form: General / 07

 HOT WORK PERMIT

Section 3. Records of Gas Tests.

Date Time Gas test Oxygen Signature of Gas Tester

test
Gas Quantity %
(specify) (% or ppm)
21.08.0 13.00 Hydrocar <1% LEL 20.9% vol c/o RR
9 bon gas

Tests should be carried out at intervals not exceeding two hours

Section 4. Permit Cancellation

To be signed by an Officer when the job is complete or the permit has expired and all potential sources
of ignition have been removed from the place of work and checks have been made to ensure there is
NO evidence of fire.

This Permit is Cancelled.

Name: __________________________ Signed: ________________________

Date: __________________ Time: ___________

QMS Amendment No. 0 Issued: 01/01/04 Page 2 of 2 QMS Form: General / 07