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27f Line Break Permit

This document is a line break permit that details the personal protective equipment (PPE) required and safety procedures for breaking a line. It requires approval signatures from client operations, Fluor supervision, and the persons making the break. The second page lists planning items like the locations of safety showers, eyewashes, fire extinguishers, and the planned escape route. It also has a section to document if any PPE requirements are relaxed after the break is made.

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Mohammed Minhaj
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961 views2 pages

27f Line Break Permit

This document is a line break permit that details the personal protective equipment (PPE) required and safety procedures for breaking a line. It requires approval signatures from client operations, Fluor supervision, and the persons making the break. The second page lists planning items like the locations of safety showers, eyewashes, fire extinguishers, and the planned escape route. It also has a section to document if any PPE requirements are relaxed after the break is made.

Uploaded by

Mohammed Minhaj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ATTACHMENT F

YANSAB

L I N E B R E A K P E R M I T
CONTRACTOR NAME SUPERVISOR

WORK LOCATION REQUESTOR NAME DATE

DESCRIPTION OF WORK:

SPECIAL INSTRUCTIONS:

PERSONAL PROTECTION EQUIPMENT REQUIRED CHECK OTHER PROTECTION CHECK


YES NO METHODS YES NO
Air Pack – Approved Barricade - _________ Radius (Above/Below)
Boots – Rubber Boots Blanks To Be Installed
Coveralls -Tyvek Block Valve Shut
Film Badge Blower
Glove – Long Gloves Fire Extinguisher
Gloves – Leather Gloves Grating, Floor Opening Covered
Gloves – Rubber Gloves Lock Out Plan Required
Goggles Piping Support Installed/Needed
Hood – Acid Hood Planning (Line Break Planning Items Page 2 completed and
distributed to all personnel involved)
Respirator – Full Face Respirator
Respirator – Half Face Respirator Pump Locked Out
Shield – Face Shield Spark Proof Tiles
Shield – Special Shielding Standby Person
Suit – Acid Suit System Less Than 100 degrees C.
Suit – Hot Suit System Vented

Suit - Rain Valve Locked Out


Other: Water Hose
Other: Other:
Other: Other:
Other Other:
Other: Other:

APPROVAL SIGNATURES

APPROVER SIGNATURE DATE


CLIENT OPERATIONS REPRESENTATIVE
FLUOR SUPERVISON

PERSON MAKING BREAK

PERSON MAKING BREAK

H:\000_General\Share\103\Safety\27f-Line-Break-Permit.doc Page 1 of 2
ATTACHMENT F

PLANNING ITEMS FOR LINE BREAKS

1. De-pressurizing, Cleaning, and Venting Check

2. Nearest Safety Shower Location (If greater then 50 feet, water


hose will be provided)

3. Nearest Eyewash Location

4. Cold Pak Location

5. Scott Air Pak Location

6. Fire Extinguisher Location

7. Fire Alarm Location

8. Stretcher Location

9. Planned Escape Route

RELAXING PERSONAL PROTECTIVE EQUIPMENT REQUIREMENTS

Date: Time:
Personal Protective Equipment Reduced To Items Shown Below:

APPROVAL SIGNATURES

Approver Approver’s Signature Date

Client Operations Representative


Supervisor
Person Making Break
Person Making Break

H:\000_General\Share\103\Safety\27f-Line-Break-Permit.doc Page 2 of 2

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