PHTHALIC ANYDRIDE PLANT
COLD WORK PERMIT
(FOR INSTRUCTIONS PLEASE SEE BACKSIDE OF COPY CARD) S.NO._________
_
Permit is valid from _______ to _______ Hrs. Date ____________
This permit is issued to Mr. _______________ Dept. ___________
to perform the following work in ______________________ Area
_____________________________________________________
_____________________________________________________
Write YES / NO or a CROSS x if not applicable. YES / NO
1. Equipment electrically isolated.
Isolated by ___________________________
2. Safety locks / tags to be applied.
3. All necessary valves closed / locked / tagged.
4. Equipment depressurized / isolated / drained /
purged / flushed
5. Oxygen % age test required. If yes,
% age O2 ___________________________
6. Units affected by this work notified
7. Name of the person to invigilate _______________________
_________________________________________________
8. Any other precautions _______________________________
Protective Equipment Required
Leather Gloves Face Shield Apron
Rubber Gloves Rubber Shoes Goggles
Breathing Apparatus None
I, hereby declare that the supervisor & workers had been informed of
the hazards involved for the cold work and they are to exercise due
care and comply with the safe work procedures.
Permit Issued By: ______________ Name: _________________
Signature Asst. Mgr. / Shift Engineer (Process)
Acknowledged By: ______________ Name: _________________
Signature Production Mgr. / Dty. Mgr. (Process)
I have checked the precautions taken and agree to work safely. I am
responsible for cleaning the area on job completion and notify the
Issuing Authority.
Permit Received By: ____________ Name: _________________
Signature Mgr. / Asst. Mgr. (Maintenance)
Safety Assessment
I certify that the work space had been assessed by me and at the time
of inspection it is satisfactory and fit for the nature of cold work to
be carried out.
Permit Checked By: _____________ Name: _________________
Signature Mgr. / Asst. Mgr. (HSE)
Job Completion
When job is completed the card copy to be signed by Receiving
Authority & Exchanged with Original.
Job Complete Job Incomplete
Time __________ Date ___________ ________________
Receiving Authority
Isolation removed. Area and Equipment checked and found clean
and in safe condition. Permit stands completed.
Time ___________ ________________
Issuing Authority
Permit Extension (Max – 8 Hrs.)
Extended up to __________ Hrs. Date ____________
_______________ ________________
Issuing Authority Receiving Authority
PHTHALIC ANYDRIDE PLANT
COLD WORK PERMIT
(FOR INSTRUCTIONS PLEASE SEE BACKSIDE OF COPY CARD) S.NO.___________
Permit is valid from _______ to _______ Hrs. Date ____________
This permit is issued to Mr. _______________ Dept. ___________
to perform the following work in _______________________ Area
______________________________________________________
______________________________________________________
Write YES / NO or a CROSS x if not applicable. YES / NO
1. Equipment electrically isolated.
Isolated by ___________________________
2. Safety locks / tags to be applied.
3. All necessary valves closed / locked / tagged.
4. Equipment depressurized / isolated / drained /
purged / flushed
5. Oxygen % age test required. If yes,
% age O2 ___________________________
6. Units affected by this work notified
7. Name of the person to invigilate _______________________
_________________________________________________
8. Any other precautions _______________________________
Protective Equipment Required
Leather Gloves Face Shield Apron
Rubber Gloves Rubber Shoes Goggles
Breathing Apparatus None
I, hereby declare that the supervisor & workers had been informed of
the hazards involved for the cold work and they are to exercise due
care and comply with the safe work procedures.
Permit Issued By: ______________ Name: _________________
Signature Asst. Mgr. / Shift Engineer (Process)
Acknowledged By: ______________ Name: _________________
Signature Production Mgr. / Dty. Mgr. (Process)
I have checked the precautions taken and agree to work safely. I am
responsible for cleaning the area on job completion and notify the
Issuing Authority.
Permit Received By: ____________ Name: _________________
Signature Mgr. / Asst. Mgr. (Maintenance)
Safety Assessment
I certify that the work space had been assessed by me and at the time
of inspection it is satisfactory and fit for the nature of cold work to
be carried out.
Permit Checked By: _____________ Name: _________________
Signature Mgr. / Asst. Mgr. (HSE)
Job Completion
When job is completed the card copy to be signed by Receiving
Authority & Exchanged with Original.
Job Complete Job Incomplete
Time __________ Date ___________ ________________
Receiving Authority
Isolation removed. Area and Equipment checked and found clean
and in safe condition. Permit stands completed.
Time ___________ ________________
Issuing Authority
Permit Extension (Max – 8 Hrs.)
Extended up to __________ Hrs. Date ____________
_______________ ________________
Issuing Authority Receiving Authority
PACHEM GLOBAL (PVT) LIMITED
INSTRUCTIONS FOR COLD WORK PERMIT
1. This work permit is valid for cold jobs only.
2. For hot work or confined space / vessel entry,
separate work permit will be issued.
3. This work permit is valid for the time specified on
it.
4. The job specified on this work permit will be done
only by the person whose name has been mentioned.
5. If the work extends beyond the validity period, the
permit can be extended up to maximum of 8 hours.
After 8 hours extension, new cold work permit is to
be issued.
6. Separate work permit will be issued for any other job
not stated on this work permit.
7. Addition, deletion or cutting / crossing of words can
make the permit invalid.
8. In case of emergency, all jobs as required through
this work permit will be safely suspended. When
emergency is over, new permit is to be issued.
9. In case the job is interrupted or suspended for 2
hours or more, new permit will be issued.
10. Upon completion of the job, the Receiving
Authority or his nominee will exchange card copy
with paper copy from Issuing Authority.
11. The Issuing Authority should retain card copy for up
to 15 days.
