Cold Work Permit Version:

Permit No. :
07/2015
...........................................
Permit Issuer: ...........................................
Oiltanking Matola, SA Date & Time: ...........................................

Authorized Permit Applicant

Department: ………….................................................................................................. Name: ………….........................................................................................................

Planned Work
Description of work: ........................................................................................................................................................................................................................................................................................................

Location of work: ......................................................................................................................................................................................................................... (add sheet for map, if required)

Equipment to work on: ........................................................................................................................................................................................................................................................................................................

Equipment to be used: ........................................................................................................................................................................................................................................................................................................

Expected period of work: From ............................................ (date) ............................. (hrs) to ............................................ (date) ............................ (hrs)
Performing company: ............................................................................................................... Number of people: ........................................................................................................................

General Safety Check

In case of an emergency the control room must be informed immediately by terminal telephone (12345) or VHF.
 All contractors have received an HSSE induction
 Job-based risk assessment must be carried out (attached to permit), document no. : …………………………………….
 Contractor have been briefed on the fluids contained in the neighbouring equipment
 Pressure relief valves have been vented to safe areas
 Contractor has been provided with a terminal radio or other means of communication for emergency situations
 Operations department has been informed about the works planned
Permit Requirements
A field check has to be carried out to fill in the status of the requirements. Status
 Work site has been barricaded, adequately marked and does not block emergency exits and equipment or escape routes
 Welding must be conducted by approved welder who holds valid welder’s pass for welding process and joint type to be applied
 Equipment must be de-pressurised/flushed/drained/purged, checked for leakage and is free of hazardous material
 Electrical equipment must be locked out / tagged out LOTO tag No.: …..……….............……
 Immediate work site must be cleared from combustible materials, spark/flash screens/barriers have to be placed
 All related pipe work must be physically isolated by  disconnecting  blind-plating
 All nearby (at least 15 m range) vents, drains, sample points, sewers, pits and other openings have to be sealed
 Ventilation is needed  natural  mechanical
 Equipment to work on must be earthed
Special instructions (use additional sheets if required):

The following safety and fire fighting equipment must be provided or activated at the work site:
 Fire extinguisher  Powder extinguisher  Firehose/ branchpipe  Firewatch (name: …...………..……)
 Foam car  Fire fighting truck  Fixed fire monitor  Others .....................................................
Other permits required:  Electrical Work Permit  Excavation Work Permit  Radiation Work Permit
 Vehicle Entry Permit  Confined Space Entry Permit  Working at Height Permit
Personal Protective Equipment
Minimum PPE in the restricted area are helmet, antistatic/product resistant safety shoes & antistatic clothing covering arms/legs.
The following additional protective equipment is required:
 Safety glasses  Protective gloves  Dust respirator  LEL / O2-Meter with alarm
 Safety goggles  Overall  Mask with filter ......................................  Personal H2S detector
 Face shield  Chemical protective suit  S.C. Breathing Apparatus  Life jacket
 Ear protection  Rubber safety boots  Safety harness/line  Others........................................................
Permit Approval & Validity
Permit is valid (for one shift only) when completed by authorised Oiltanking personnel and signed. The validity must be extended if
work is allowed to be continued after expiring. The permit is automatically suspended in case of an emergency or changes in work site
conditions making it unsafe to continue the work. The work can only be resumed upon clearance from the approving authority.
Authorised Permit Issuer Authorised Permit Receiver
I confirm that the work site was inspected and all necessary measures I accept the permit and confirm that work will be carried out safely
have been taken to ensure the work is carried out safely. subject to fulfilment of the permit conditions and requirements.
Date: ............................................................ Time: .............................................................. Date: ........................................................... Time: ...............................................................
Name: ............................................................ Signed: .............................................................. Name: ........................................................... Signed: ...............................................................
Permit & Work Status
The permit must be returned in case of cancellation, after suspension or completion of the work.
 The work has been suspended. Authorized Permit Receiver:
 The permit has been cancelled. Date: ............................................................. Time: ..............................................................
 The work has been completed and the permit is herewith invalid. Name: ............................................................. Signed: ..............................................................
(Work site has been cleared, cleaned, equipment has been returned.)
Authorized Permit Issuer:
Date: ............................................................. Time: .............................................................. Date: ............................................................ Time: ..............................................................

Name: ............................................................ Signed: ...............................................................

All rights reserved. This document was prepared to control safety relevant work on Oiltanking facilities only. No warranty is made, either expressed or implied.