CONFINED SPACE ENTRY HOT WORK EXCAVATION ELECTRICAL WORK
PART I WORK DETAILS Company SNC-Lavalin Sub-Contractor Crew Size(#): Company: Date Issued: D M_ Y Time Issued: Date Expired: D M __Y __Time: __________________________ Extended Date: D M Y Extended Time: Extended by: Emergency Meeting Point(s): Location: Description of work to be done: Additional Documentation Needed (Attach): JSA Electrical Diagram Utility Locates Training Records P&ID Inspection Records Lift Plan Engineered Critical Lift Plan MSDS Soil Characterization Equipment Calibration Rescue Plan Traffic Control Plan PART II FOR HOT WORK ONLY (Mark each box as applicable) Welding Cutting Brazing Torching Explosive Actuated Tools Grinding, Drilling or Soldering (If flammables are present) Other (Describe): PART III HAZARDS (Mark each box as applicable) Yes No N/A Yes No N/A Yes No N/A Hazardous Chemicals O/H power Ignition source Live electricity U/G power Flammables SO2 U/G piping Combustibles Low O2 U/G gas Poor/extreme lighting LEL Slips, trip and falls Extreme cold / heat High pressure Congestion / obstruction Collapsing soil/spoils Airborne hazards Public interaction Radiation Yes No N/A Pinch point Moving parts O/H hazard Hoisting / Lifts Others:
PART IV CONTROL MEASURES TO MITIGATE HAZARDS (Mark each box as applicable) Yes No N/A Yes No N/A Yes No N/A Pre-job meeting Isolation /Lockout Welding Screen Group notification Tagging Scaffolding Drain equipment Air mover Flag person Purge equipment Ventilation Grounding Steam equipment Barricading (hard/soft) Chock wheels Flush equipment Railing Slopping De-energization Clearance Cut Back Yes No N/A Shoring Guarding Interlocking Signage Others:
PART V ADDITIONAL PERSONAL PROTECTIVE EQUIPMENT REQUIRED (Mark each box as applicable) Yes No N/A Yes No N/A Yes No N/A SCBA / SABA Chem-resistant gloves Life line Full face respirator Chem-resistant boots Fall arrest Half face respirator Goggles FR clothing HazMat suit Face shield Hearing protection Yes No N/A Personal air monitor Radio Others:
PART VI ATMOSPHERIC MONITORING REQUIRED NOT REQUIRED
Type Flammable Vapours
Oxygen SO2 Others:
Test to be repeated every (Min) Continued Monitoring Monitoring results attached: Yes No Monitoring Location: Tested By (Print): Signature: _________________________________________
Time
% LEL or PPM
Target
<5% LEL
19.5% - 23%
5 PPM
PART VII THIS DOCUMENT HAS BEEN READ, UNDERSTOOD AND AGREED BY: Open Permit Permit Reviewer (EPO Supervisor): Permit Reviewer (Outotec Supervisor): Permit Reviewer (EPO HSE): Permit Reviewer (Outotec HSE): Signature / Date:___________________________ Signature / Date:___________________________ Signature / Date:___________________________ Signature / Date:___________________________
Permit Issuer: Signature / Date: Permit Receiver: Signature / Date: Permit Transferred to: Signature / Date: Closed Permit Permit Receiver Sign-off: Signature / Date: Permit Reviewer Sign-off (Outotec): Signature / Date: Permit Issuer Sign-off: Job completed Job not completed Area left safe, clean and tidy Yes No 6845.3.7.3-EN-Rev.03 _RTB-Bor Project Last printed 2013-08-01 Page 1 of 1
REQUEST FOR EXPRESSION OF INTEREST (REOI) FOR Consultancy Service of Project Management Consultants (PMC) For Road Safety Management (MOPIT) Under SRCTIP SRCTIP-MOPIT-CS-QCBS-19