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  • Energisation Permit

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    This document is a Lock Out Tag Out (LOTO) permit that must be completed for any testing and commissioning work. It requires identification of the energy sources that will be isolated, notification of relevant parties, use of personal protective equipment, a briefing on the LOTO procedure, and verification that all energy has been released or controlled before and after the work. The permit must be authorized by both the supervisor requesting it and the site manager, and includes spaces to document isolation methods used, checks performed, and restoration of energy after completing the work. Conditions that could lead to suspension or cancellation of the permit are also noted.

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    This document is a Lock Out Tag Out (LOTO) permit that must be completed for any testing and commissioning work. It requires identification of the energy sources that will be isolated, notification of relevant parties, use of personal protective equipment, a briefing on the LOTO procedure, and verification that all energy has been released or controlled before and after the work. The permit must be authorized by both the supervisor requesting it and the site manager, and includes spaces to document isolation methods used, checks performed, and restoration of energy after completing the work. Conditions that could lead to suspension or cancellation of the permit are also noted.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    4 views1 page

    Energisation Permit

    Uploaded by

    amenmohamm3d
    This document is a Lock Out Tag Out (LOTO) permit that must be completed for any testing and commissioning work. It requires identification of the energy sources that will be isolated, notification of relevant parties, use of personal protective equipment, a briefing on the LOTO procedure, and verification that all energy has been released or controlled before and after the work. The permit must be authorized by both the supervisor requesting it and the site manager, and includes spaces to document isolation methods used, checks performed, and restoration of energy after completing the work. Conditions that could lead to suspension or cancellation of the permit are also noted.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    LOCK OUT TAG OUT PERMIT CONTRACT No.

    PERMIT No.
    APPLICABLE ONLY TO TESTING & COMMISSIONING PROJECT/ SITE

    ALL WORK UNDER THIS PERMIT IS VALID FOR A SINGLE ACTIVITY AND PER SHIFT
    REQUESTED BY (Supervisor) DATE & TIME DURATION

    CONTRACTOR
    SPECIFIC WORK LOCATION

    DESCRIPTION OF WORK &


    HAZARDS (Must include, reason for
    activity)

    PLANT & EQUIPMENT


    IDENTIFICATION. E.g. hand tools,
    Tags (must be in English, Arabic &
    other languages understood by the
    workers), Padlocks (Minimum 2) etc.

    Requirement Yes No N/A Requirement YES NO N/A


    LOTO Procedure is developed, reviewed & approved by Supervisor
    All identified energised systems is de-energised/ isolated.
    Consultant and Employer.

    Electrician competency is assessed by Supervision consultant & proof Minimum of 2 Locks & Tags in languages understood by workers placed
    of qualification is readily available. and held by the operator/ maintenance/ supervisor.

    LOTO/ ISOLATION REQUIREMENT Energy sources have been identified & recorded. Reasons for lock out is mentioned on Tags and legible.
    (Must be completed by Competent
    Electrical Supervisor and verified on
    site by Permit Authoriser) All affected/ relevant parties have been notified. Isolation has been verified & recorded by a competent electrician.

    Task specific PPE such as electrical insulated boots & face protection
    Test equipment to verify that all energy has been released or controlled.
    is provided as stated in LOTO procedure.

    LOTO Procedure, activity briefing & Permit requirement is briefed to all HSE officer has conducted inspection to ensure LOTO procedure is
    operative & records available. adhered to as per Expo & Dubai Municipality requirement.

    Requirement Yes No N/A

    Work is checked for completion by Competent electrical supervisor


    RESTORATION REQUIREMENT.
    This must be completed after work Tools and people are clear of the equipment.
    completion by Competent Electrical
    Supervisor and verified on site by Locks & Tags are removed.
    Competent Permit Authoriser.
    Energy is restored in the presence of the person in charge/ authority.

    Energy restoration is checked for proper functioning.

    ISSUE

    I ….Supervisor …………………………(Permit requestor) confirm that this LOTO requirement have been checked and recorded at work location.
    _______________________
    I will ensure all operatives are briefed on Permit to Work requirements and the activity.
    Signature, Date & Time

    I ……..Site/ Construction/ Project Manager …. (PTW Authoriser) confirm to authorise the testing & commissioning activity (Specify if other activity) as detailed in this Permit.
    _______________________
    I confirm that I have physically checked work location and all isolation conditions is satisfactory.
    Signature, Date & Time

    HAND-BACK/ CLOSE OUT (Must be completed by Supervisor/ Permit requestor and returned to Permit Coordinator)
    Work is completed at (Time & Date): ………………….

    All equipment have been stored correctly.

    _______________________
    I ….Supervisor …………………………(Permit requestor) confirm that the work is completed and have checked operation of energy restoration.
    Signature, Date & Time

    SUSPENSION/ CANCELLATION
    Where monitoring of any type identifies contractor works which are not adequately covered by a Health and Safety MS/RA, all or specific parts of those works will be immediately suspended by the Supervision Consultant and/or the Employer until
    satisfactory action is taken by the contractor to rectify the situation.

    Conditions observed for suspension/ Cancellation of Permit:

    NAME: ……………………………. SIGNATURE .............................................. DATE .................................

    SOP-355 ATT. 7.8 Rev 5

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