Hs PERMIT COPY MUST REMAIN AT JOBSITE __ IN CASE OF EMERGENCY DIAL o4s6172222908102515 OR BREAK NEAREST MCP GURU GOBIND SINGH REFINERY | = HOT WORK PERMIT Permit No, : 200250516 [TO we COMPLETED BY PRRRIT REQUESTOR Car aE Yoru Enbear Ene Ey taints soacrwet E] veusctatpnestoy | Fes popes aro Save a SAPRRTOCR CaS ART Ti Tag LESAN 8 Tip. FILTERS CARBON LEAN rt Doctpten52.G128 meh ae bb [Took & Equipments L] Welding Machine TBA Cinder LT] Now Flime Proof Equipment [] Vehicle /Crane No. erect Fy Geena: | E} totengticiee E] aiyonaceqees E} UlleteneTeais Ob Perms requested From Due: 14.12.2021 a1: 09200:00 Hs. y roms Rew None AMERY ARAMYEER Deen MAINTENANCE -MECHANAL siemes Z wee Employes CD Comactor (Outsourced /0 & M" only) ‘Company Name {if Contractor ) nary: HEL Mince Open Sopeinw Repl wine smite) Mane ee ee errs: 4 NawcofCoanot Spor Agcy Nace: _RANIT/Vial nee Vial tpt : B [A. Other work inthe viiaity eriteal to this work O ve @ % | emis Tea Re eat | Operate! Consteatnerecattons: | Dore Soe eo rape Veta Pred Pere acer puta Pot Seen septa ent Sees Eerie f oaineatee eee } he Toten aed et te “Keep Wet Dry (spscify) Flashing ight brticading arrangement & Warming signs displayed 7 ar Caaf etpapr via cy aon vlc ; Come TAWA Seca esa i So tntes Rap Fin ie Dee pt 5 Pata Ce tenes a eT Tuning Car ents pied ie Wee ie a See eater tatege i Sipoudieneorse Suiting SAPEFORUSE'Tago NA g c. tenting fone menses are hes De Wnnee ee Few ea De Haan lb. spec Equipment Ie)" foctnnptne 1] rebintz —( vowmTuctSocsito{] Litt C] Non-Soutig Took sty }CO Running Water Hose EQ Viighing =) AicMovertcooting Unit C] — Rescucr Tripod) Spark Arrestors Others... I Aaatnnt Persea rteciveuipment (PE) (nine pent Sty Et Sty ny Sr SlCr SD & tnd or CY rae san Peet PY tentsae Cy aatwomen Eterna Gare, CY Palen ren Seytmee Esta Hcomaasa El tminghonan Bi oon l-ereretns osteo ote tom (ener) Santer Ried? Ds Thx comical? = Cvs ON Lesh eerie = nh DN Seas te Toe cspciteonion eK Pot g ani Eg OTE ETE ae z a ete tg lr palin ae melas eaenea bes ae ae 5 MLAS TEST [inal car Tst) 5 HOS PBL a Ope 05 a siNs.25 CWA 2 as. “td wom Twa Or 2 iW FER APPROVALS frecrona Satie AES ap me ee oo ae facia SoTL ee ass cocoa aid andi os mention i so eer rade vee, aBURNEER Sp en eae hee ee Pete Moonen so gaa ta: fume |. lp a oe oe MYA ee AOE | rm Ass, vaste me - es oe i ot me ua % tse ne nen oe et 4 (er [y PERMITT EXTENSION = ——— aa — Se [PERMIT CLOSE OUT raw? 2 PSI aC rc cal un ea i lol ida atom aed CITI =a fatigue * Seman wie z any cacy PETS SES NGS Ns Pom str ToPRE ENTRY CHECKLIST FOR CONFINED SPACE (To be filled up and complied before each entry into confined space. ‘The compliance shall be followed by ‘Confined space entry permit’) SI. No. 328672 i _xact Location of work : (Unit/ Area/ Equipment No)... 802.) ELMS, D. Maximum No. of entrants allowed: ‘Stand by person (Attendant) Is required for all confined space work. F Name of trained entrants for entry (Training validity 1 year) Trained on (must be “yes” only) G, Communication facility provided (Specify) .3j-A\=.2: H, Rescue Procedure established: ‘~V (must be “yes” only)| 7. All electrical equipment is of intrinsically safel Flame Proot Type? 2. Safety Signs, boards and barriers are avaliable : = BONE Tobe done 3. Debriefing and safety briofing to authorized entrants = DONE Tobe done “Are there any Hazards from falling objects into the confined space ?_ hh Are there any Operations conducted or equipment adjacent to the space yj. ‘opening which could present a Hazard to the entrants 7 &. Does the tankivesseV/Equipment contain rusted interior surfaces ?, (Potential for 0,deficient atmosphere) 7. Does the space contain any ro ting mechanical Equipment?» 6 3. Job Safety Analysis done ? <-> (must be “yes” only) ‘9. Does the space presents any slip, trip or fall Hazards ? 6 & 10. Ventilatisn Plan: Natural[—] Forced Exhaust[J Foreed Supply []_other[ _] gs 3 ON, 211 “on paz asn Bu, ‘eon si up SA Format No. 9112-000-HSE-006-00004/ Ver-2Not So ftom Rogie | ayo 1 ENERGY ISOLATION PPE 1. | The contined space nas Ful body namoss with town teolated from other lite tine provides systoms ee e [ 2. | Mechanical Equipment has 2 | scaa/ainine been blocked, shocked available ateito and disengaged “ — 3. | Pumps or lines blinded, 3. | Retrieval equipment Gieconnectod or blocked fvallabo sts ois a ‘| 7 retrieve personnel fom — Vertical ype entry spaces 4 | Whether bling tists Non sparking tools to be vailabie? eA a ted ei? az | Positive isolation of Fire Extinguisher for = Sleetrical source with “ Welding / Burning / Hot Sek Out and Fag Out Wore ©. | Other sources such as ai, _- | © | sagsteaimei cage Water, Stoam, Gas foes connsetion shall bo blinded, disconnected al available near the vessel ae orblocked a VENTILATION Eye / Face protection 4 am 1 | Mechanical (must bo air ®. | Hoisting Equipment eductors or FLP type al - ae Fe -_ for inflarmablos) 2. | Natural Ventilation only eri 9. | Personal O,Monitors: — Portable gas tester ‘Vi | Protective Clothing Checked forhealthiness | “~~ = iil od , | Continaous gas monitorin Vilt.| Gas Testing by Authorised Nw required ’ ena - Gas Safety Tester uu - V. | Radioactive Sources 1X. | Temperature Conattion ‘Nucleonic guages es as near to Ambient. sa _ Isolated ? “The control measures and protections appropriate for the safe entry and execution of the work in the confined space have been implemented and the persons required to work in the confined epace have boon advieed of and understand the requirements. ISSUER RECEIVER inte shall be complied by entry engineorirecelver and checked by Issuer. NOTE: 4. Pre entry confined space checklist shall be used every confined space entry permit. 2. No confined space permit shall be issued, till the requirements of checklist are complied. Page 2 of 4 2.__|lsthepermi uly approved ax per authorization required?” 3.__|ste standy Air Suply respirator SCBA available wt cite?omy eye | HMeL JOB SAFETY ANALYSIS FORM Main Activity: Confined space entry Plant & Location:SRU Date: Wenz Daya Dayz Days Daya Days Days Day? Permit Nos. (Day 1-7) Qa D=2350N6 ‘SiN. 2-2 IWES, ‘Sub Activites Lstthe tasks required to perform the activity inthe sequence they are caried out Hazards (Goth Existing as wellas potential) ‘Ags each task ist the Hazards that could cause Ijury/damage to people, equlpment or he environment. ‘Contr esburar LUst the contral measures required to eliminate or miinee thers of Injury arising from the identified Hazard, Preparton or man airy eau asad tony diecy one at nd het enrnmont sure held vpn he ves alanis enple et and decontaminated ‘Alvalesidntfed must be completely care, tagged ond cone Far ot asi ard 0 NOT OPERATE Tag rowed ‘Alte process, uty net gas conection mune connected pose ince before sowing man entry ‘Alsch cations mus e prepared. The same mus be checked oy b permit. ‘sar scepter before abowing Man Ene Froer ai purging ust nse Mate exaust and lows arargenet fos te fom, open he Check O2/H2S eel Ens vl's 20.9% 2S NL althe ins Pre did the frequency of 02 thing and mark same onthe pert Keep 02 ana HS meter with working ce {rowan hare of confine space nya than 0 de before entering te heater Prove the 00 NOTENTER WITHOUT PERMIT board infant ofthe other Fallow canoes space etry sraceoure Ensure Evacuation plan prepared and Hrathad wah the pen ool or ato be gent working due pretence of proper material “ey prophore mater sh lun ru Be removed copii {suipete rea must HepEWEL ah ere ado var iF Aphese | oi retin susces connected othe equipment Working side Tankassytt ropaemie aman) sre presen of standby pertn, wentngdertfcten Tap al he Tne ‘Alon one ety gor the same must be ued ahs ex point No mul yet poi ‘Maintain ent registr kegp the hen count of person essevcatunn ring the Neath asad due to ongen defen, onc em das ‘Use fet harsh doable We Tne nd Une hood to ply out ‘ves or easy cuacuation Sandy person shoul be in communication wth working crew fan pan andi shouldbe explained to working row Mani ester shoul be epaates ep SCABA a ne mask read net vessl for eacuation tng on wal / Escape route not dea /Uneensious prion ulnar jou eakh Use ust mask, ves an Roy apn forhanding Plea pment da wba Not erg rogonmie Maran eer) ‘Alperson must have come et Before boxing up. elena Enya, EWE ‘arrngeal nde, py exemin the erin ab eaves 14) ‘aly in whe wi Use exec 08, Use mandy PP “te: 4. ISA to be done by issuer and acceptor of work permit. In case required, representative from other discipline can also join the team for JSA. "® \inimum one hand written job speci from above" in the Remarks. |\YSA to have approvals*(Managers) for Hot Jobs, confined space entry & Work on equipment in service information to be included every day by the Issuer & requestor. In case of no additional information, write-"NoFR, Tie = (ia LY emer wre =| del “i a = ee AV ire Mie) purge Bren serie fp pametnal TS | Alo velet pe 1 3 IB Yberih-coteby] -S ®D \} ee Se brovces| YS fens yonrseeeer de wy ry ye vw om ea] vaverrzewz | rrzairzozees way mr wd ¥e| Se ee ee an we wy ve gee MEM | ons ve] verwezcewsee | ccnwswrareceo | Te[W yc a ‘mains nPreMo} — —— —— a = “{HE PMESENT BOGINENT ORV THE PROPENY OF TEGHP AO SLL ACT LOR Al UREUMSTACHS Be TOTALLY ORPMTL,GRORECTLY OR UNDRECTLY, HAWSFERED REPRODUDED COMED GSCLOSEG OR UE WHFS a | Fyn 0 125 [onoze, fit Review Code een | cemnzish (azs9y wore worea coreySee 2 HPCL Mittal Energy Ltd. /HPCL Mittal Pipelines Ltd. Teen heed \ Wa Confined Space Entry Procedure aibeed i (rmet 9112.000-HSE-006-00039 Fe Bots Annexure-3 lan for Confined S| ‘The on-Site Rescue Plan is the part of he work permit for the confined space and willbe attached with permit. Prior to entry in the confined space: 4. The job supervisor will ensure that all safety precuation / control measure & rescue equipment identified in permit & JSA for the confined space has been complied and available at work site. 2. The Job supervisor will ensure that an adequate number of trained rescue persons are available for immediate rescue operation in confined space til arrival of Emergency Respond Team. 3. The Job supervisor will ensure that an adequate trained entrent are available to perform the activity in confined space. 4, Job Supervisor will ensure that gas testing being done by AGST & mentioned in permit. The attendant establishes communication with all workers who will be in confined space, using the means described in the attached JSA. i 6. _ Incase of emergency the attendant will immediate report 0... FE & FS through Walky talky or $ phone on given number 01656... ISNO: BOS O16 PD While working in the confined space: 1, The attendant who is stationed outside and near the entrance to the confined space shall remains in constant communication with all workers inside the confined space. 2, The attendant must be noted immediately if an entrant recognizes: ‘a. unusual action’ behaviour an unexpected hazard . anunsafe act or ._ detects a condition prohibited by the permit | 3. Enlrants must exit the confined space as quickly as possible, when: fe. an order to evacuate is given by the attendant. an entrant recognizes a sign or symptom of over-exposure g. atvunacceptable condition arises Fesmate,91-D10°CTO07-0008Reea0x # Con XoO\ WEYL 1 PRE-JOB DISCUSSION Et of : amet Description of Job: bddcha=|08.2. Aaside..Bulling dvad...Quiuti ‘ ‘Steps Involved in Job: 1 Pokomit ao Wort 2 Gmfind Space entsy % Buffirg Job 4 Pintivg Jvb 5. Howe hd 0 Equipment to be used: ‘Name of Equipment Required (VIN), “Tagging & Condition (OKINot OK) ‘Scaffolding Nn — Liffing Toolsfiackles/equipment Sie == Electrical too!s (Portable/Fixed) ye & Hand Tools Ye» or Ladders pL — Vehicles F3) ae ‘Others: nN = Job Specific PPE's: Wye. poSe.mnoMily..Lndtlaby/ Nae. wed Sateldnnt Sai done ie’ = Lae Bulg tol }- Dust Hordds, Ye Mysurt 1 Body Dro! Teamuwadre WE Facer Miedy We Loder(ovs, We NS APPL. fale Application’ Bein Pept, Le body da Dut *O PAiwt A yrAKWA T- Lye NoS|E WASH, Purdoer_(Hlove , Lahey Koy Hazards (including hazards from plant area) and Control Measures: Belhowe Gnior WL Confivad Cuack 0g; Had; Leudps Rueakees Mowe Taphg a Wa Rite