JR Shipping Lines Inc.

COLD WORK PERMIT

FLEET MANUAL Issue: 00/202212 Revision: 01/2024/12

CAPTER 8
Checklist

This permit relates to any work in a hazardous or dangerous area which will not involve
generation of temperature conditions likely to be of sufficient intensity to cause ignition of
combustible gases, vapour or liquids in or adjacent o the area involved. System shall be Tagged
out at required.

Vessel: Place
Date:
Section A: General

This Permit Is valid From: Date:

(not exceed 12 hours) To:
LOCATION OF COLD WORK:
Has an Enclosed Space Entry Permit? YES/NO
Has an Electrical Work Permit been issued? YES/NO

Description of Cold Work

Personnel Carrying out cold work

Responsible Person in attendance

Section B: Preparation and Checks to be carried out by Officer in Charge of cold Work to be
performed.

NO. The equipment. Pipeline has been prepared as

ows

1. Depressurized/vented Yes N/A

Washed Yes N/A

Drained Yes N/A

Purged Yes N/A

Inerted Yes N/A

Other remarks:

Is equipment/pipeline has been isolated as follows:

 2. Lines blanked Yes N/A

Lines Disconnected Yes N/A

Valves closed Yes N/A

Other Remarks:

3. Is equipment free from:

Oil Yes N/A

Gas Yes N/A

H2S Yes N/A

Steam Yes N/A

Pressure Yes N/A

4. Is surrounding area free from hazards? Yes N/A

5. If work to be performed on electrical equipment has Yes N/A

equipment been isolated and TAGGED to prevent
onnection and energizing?

Section; C - Information and Instruction to persons involved with cold work.

1. Personal Protective Equipment used.

2. Equipment/pipeline material in service .

3. Hazardous material expected when

ipment opened

4. Special conditions/precautions.

Section: D - AUTHORITY TO PROCEED WITH THE WORK

Name & Signature Time: hrs

(Safety Officer/Master/Responsible Officer)
Name & Signature
(Person Carrying out work task or incharge of cold work team)

Section: E - CONFIRMATION OF COMPLETION OF WORK

This work for which this permit was issued has been completed and all persons materials and equipment have been withdrawn.
Tags and locks have been removed ( where applicable) and all the work area has been left in a clean and safe position.

Name & Signature Time: hrs

Safety Officer/Master/Responsible Officer Date: