Checklist for Cold Work permit

This permit relates to any work in a hazardous or dangerous area, which will not involve generation of temperature conditions likely to be of sufficient intensity to cause ignition of combustible gases, vapours or liquids in, or adjacent to the area involved.


This permit is valid From ______________________________hrs

Date: ___________________

(Maximum validity 12 Hrs) To _____________________________ hrs     

Date: ___________________

Work Location:                 __________________________________________


Description of work to be done: ______________________________________


Equipment To Be Used : ___________________________________________


Names / Ranks authorized to work: ____________________________________



Section 1

Preparation and checks to be carried out by Officer in Charge of the work

Yes N/A
1 Has  a formal  risk assessment been prepared and  discussed by the personnel working ?    
2 Has the  Equipment /Pipeline been sufficiently drained/cleaned ?    
3 Has the area been thoroughly cleaned free from debris /hazards  ?    
4 Is  the  Equipment /Pipeline   free of oil residues and adequately vented to atmosphere?    
5 Has the space been positively segregated by blanking off or isolating all connecting pipelines?    
6 Has the Equipment/Area been tested for  gases ( HC ,H2S ,Others )?    
7 Are Lock Out tags/notices in place where  applicable?    
8 Are all equipment in use of an approved /certified type and intrinsically safe to use?    
9 Have all personnel used the appropriate personal protective equipment?(specify)    
10 Any other permits involved with this job ? Please specify?    
I am satisfied that all appropriate safety  measures are in place and that the work can be conducted safely. Name, Rank and Signature of Responsible Person
Work Authorised By: Master / Chief Engineer

First Copy for display at work area.Second copy for Ship’s recordsNOTE:Cold Work permit to be issued for all jobs involving blanking / disconnecting / connecting pipe work, removing and fitting of valves, blanks, spades or blinds, work on pumps, clean-up of oil spills and any such other work.

Equipment /system has been de-isolated and returned to the “in-service condition”  
All notices and tags removed  
The work area and equipment is in a safe condition  
 Work Completed                            Permit is time Expired   Work suspended  
Permit Closed By Responsible Person : Signature : Date :


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