SKAI AIR CONTROL PVT LTD.

PRESSURE TESTING - PERMIT TO WORK

1. Project information: (To be filled by initiator /originator)

Project Name Permit No:
Project Location
Requesting Contractor /Company

2. Permit Issuance Details: (To be filled by initiator /originator)

THIS PERMIT IS ONLY FOR ONE TEST AND I
EXTENDABLE
Description of task:

permit validity: TO
Design pressure of pipeline: Operating pressure:
testing pressure: pressure time:

3. Pressure testing Details: (To be filled by initiator /originator)

Type of work request
Type of Equipment testing:
Dimension: Pipeline/ Tank/ hose
Attachments:
Hydostatic □ Pneumatic □ Gravity testing □ Other: □
Pipeline □ GRP □ AC □ Tank □ hose □ other: □
Diameter □ Thickness □ Leanth □ Other □
Plan □ sketch□ Drawing (approved) □ MS & RA Assessment □ Authority Approva
Road traffic approvals (if applicable )□ Other □

4. Prerequisites : (To be filled by initiator /originator and verified by Evaluator

Checks point YES/NO/NA Checks point

Is the segment of pipeline under tesring isolated service by closing MS & RA developed approved and
nearest valves ? communicated
Is the liqiid /gas vented/ removed from the pipeline testing & monitoring of the
environment prior to entry
Test head and End plug /End point properly sealead / secured Emergeny response procedure and
/tighten rescure plan are developed &
communicated

Is Air vented compltely by pumping and filling the water in the Operatives are trained and
testing segment pipeline with out pressurizing competent

Pressure testing equipment in good condition with available safe Provision of vigilance supervision
guards
Flexible pipe /hose are in good condition and connection are Proper barricade and signage are
sefely clamped posted
Pressure testing guage have valid calibration Safe means of access / egress
provided
Pressure testing guage /valve are in safe & accessible place out mens of communication available
side restricated /isolated area
Is the testing pipeline /vessel/tank are properly isolated Electrical equipment & connection
safe
Is the confined space PTW required & obtained Other:

5. Acknowlegement by Initiator and Evaluator :

Acknowledge that all above precautions have ben taken . These have also been fully explained to the operatives and consi
competent to do it safely

Initiator / Orgiginator /name : Designation :

Signature : Date / Time :

Acknowledge that have checked above control measure and cosider the work are safe to cary out the activity
Evaluator ( hse team ): Designation :

Signature : Date / Time :

Comments (if any ):

6. Authorization Project Manager & Project Engineer

Name : Designature :
Signature : Date / Time :

7. Completion / Cencelation of permit

Acknowledge that the area have been restored to a safe and orderly condition
Initiator signature : time :
Acknowledge that i have checked the are and been restored to a safe and orderly condition
Evaluator signature : Time :
 D.

RK

ONLY FOR ONE TEST AND IS NOT

Date

ng □ Other: □
e□ other: □
her □
essment □ Authority Approvals (NOCs) □

Checks point YES/NO/NA

veloped approved and
ted
onitoring of the
t prior to entry
esponse procedure and
are developed &
ted

are trained and

vigilance supervision

cade and signage are

of access / egress

mmunication available
uipment & connection

ed to the operatives and consider them

y out the activity