VT4 PTW Template

EVN GENCO3/VTTPMB
DMPP Consortium
Vinh Tan 4 Thermal Power Plant Project

(2 x 600 MW)
Attachment 1
HOT WORK PERMIT
Company:
Date:
PERMIT REQUIRED FOR
WELDING
GAS CUTTING
BRAZING
GRINDING
Others
Location:
Section I
DETAILS OF THE PERMIT RECIVER (SC = Sub Contractor, DHI = DOOSAN)
Permit Receiver (SC)
Contact Number
Engineer Responsible (DHI)
Contact Number
Safety Advior on Site (SC)
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Valid Till
Extended Date
Valid Till
Extended Time
Permit Contents:
Valid Till
(Not more than a week)

(Expires after 0001 hrs)
1) Permit to Hot Work (Two copies one for site one for EHS file)
2) Method Statement and JSEA (Copy for Site)
3) Personnel Training Record Sheet (To be placed in EHS file)
HOT work permit shall not exceed its duration for more than seven (7) days.
Work Permit shall be renewed on the Eighth (7th) day WITHOUT FAIL
Section III
PREREQUISITE
for YES and X for No
(Work May be stopped if one of the following is not complied with)

Yes/
No
NA
Flammable Materials removed from location
Appropriate Working Platform
Welding Gensets terminal insulation
Safety/Warning Signs in place
Adequate Earthing
Adequate Ventilation
Area of work clean and dry
Condition of the welding cables
Appropriate Fire Extinguisher Provided
Adequate illumination
Operatives trained in using fire extinguisher
Flash Back arrestors - Gas Cylinders
Fire Blankets (non flammable) Provided
Cylinders Kept in trolley and secured
Fire Watch Personal
Regulators in good condition
Area barricaded
Gas test required
Appropriate PPE Provided
Isolation of Equipments required
Declaration by the Permit Receiver
Yes/
No
NA
Name and address of Permit Receiver
I_________________ representing _________________ hereby declare that I
Company Name:
have checked the location and the welder has been briefed about the emergency
Nature of Job: .
procedure and a toolbox talk given on using the fire extinguisher to ALL involved
Tel.No
in the activity.
Email
Date: // Name; . Signature;
Contact Number (Site Safety Rep)..
DOC. NO. VT4-VA08-P0ZEN-7500033
Rev. C
Page 4 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV

(2 x 600 MW)
PERMIT APPROVAL
Reviewed by Doosan Manager: Signature Date .../.../..

Comments.
Work shall be carried out ONLY after complying with the precautions given in Section III of this Permit.
The permit is valid up to _______ hrs. On
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected from
the main source of power supply.
Name of the Doosan EHS Manager:.... Signature Date .../.../..
Comments
PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Project Director
Subcontractor
Site Manager
Doosan Civil/
Architecture Manager
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 5 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 2
PERMIT TO EXCAVATE
Company:
Date:
Excavation
PERMIT REQUIRED FOR

Section I
LOCATION:
DETAILS OF THE PERMIT RECEIVER (SC = Sub Contractor, DHI = DOOSAN)
Task Supervisor/Foreman(SC)
Contact Number
Contact Number
Safety Advisor on Site (SC)
Contact Number
Section II (Eng. Responsible)
PERMIT VALIDATIONS
PERMIT ISSUE DETAILS
Date ____________________
Time ________________
NO EXTENSION WILL BE GIVEN

ON THIS PERMIT
PERMIT EXPIRY DETAILS

Date ____________________
Time ________________
Permit Contents:
1) Permit to Excavate (Two copies one for site one for EHS file)
4) Drawing
ALL EXCAVATIONS IN EXCESS OF 1.2M DEEP SHOULD BE APPROVED THIS PERMIT.

THIS PERMIT IS ONLY TO BE USED BY THE PERSONS TO WHOM IT IS ISSUED. ON COMPLETION OF THE TASK OR ON EXPIRY THE
PERMIT IS TO BE RETURNED TO THE ISSUER FOR CANCELATION
Section III (By SubContractor)
PREREQUISITE

A
Yes/No
NA
Is the Work Area Clearly Defined? Have the Latest DOC

drawings been Consulted?
Has the Area been Checked Underground Utilities?
Are All Service Locations Clearly Marked?
Have All necessary Trial Trenches been Excavated?
Has a Risk Assessment been Completed for the Task of

Excavating Near the Services?
Have The Operatives for the task been briefed on the Risk
Assessment. Is this Signed for?
(Work May not commence if one of the following is not complied with)
Are the Required Controls in Place as per the Risk

Assessment?
Attended Briefing
Details of Employees working

in the Excavation
Name, Company
Services indicated by walk through with

operatives designated to the task and safe
exclusion zones been indicated by barriers.
Water / Sewer / Irrigation / Drainage

( 1m Exclusion)
Electrical 11 Kv or Higher Voltage

(3m Exclusion)
Electrical Lower than 11 Kv (1m Exclusion)
Telecommunication (1m Exclusion)
Oil/Gas (10m Exclusion)
Overhead Services (Contact Service owner)
Other (including Structures)
8
Planned Equipment For
Excavation
Declaration by the Permit Receiver (SC)
Yes/No
Allowed / Disallowed
I_________________ representing _________________ hereby declare that I have

checked the location and all the employees have been briefed about the emergency
procedure and services associated with this area of excavation.
Date: // Name; . Signature; ..
PTW CANCELLED:
Rev. C
By:
Page 6 of 29
NA
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV

(2 x 600 MW)
PERMIT APPROVAL

Comments.
Reviewed by Elec. Dept Manager: Signature Date .../.../..
Comments.
/
/
Comments

Project Director
Subcontractor
Site Manager
Doosan Civil/
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 7 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 3
CRANE OPERATING PERMIT
Company:
Date:
Crane Operation
PERMIT REQUIRED FOR

Section I
LOCATION:
Task Supervisor/Foreman(SC)
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Valid Till
Extended Date
Valid Till
Valid Till
Extended Time
Section III
PREREQUISITE

Yes/No
NA
Lifting procedure/prepared/planned?
Main brake system functioning?
Crane inspected/Jibs good condition?
Safety/Warning Signs in place?
Work area in safe-condition?
Winch brake system functioning?
Lifting calculation completed/Load Test/Charts?
Ground stability checked?
Height clearance completed?
Stability of crane outriggers?

Dedicated signalman (one person only) with
vest?
Shackles inspected?
Slings inspected with certificates?
Weather in good condition?
Spreader bar inspected?
Area supervisor/safety personnel

supervision?
Reverse alarm & lights functioning?
Fire extinguisher in place?
Doors & windscreen good condition?
Steel plates (where required)?
Crane :
Type :
Model No. :
Yes/No
NA
Vehicle No.:
Year of Manufacturing Crane :

Operator Name:
Operator Certificate No.:
Maximum Weight of the Load:
Company Name:
have checked the location and the welder has been briefed about the
Nature of Job: .
emergency procedure and a toolbox talk given on using the fire extinguisher to
Tel.No
ALL involved in the activity.

Email
Rev. C
Page 8 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV

(2 x 600 MW)
PERMIT APPROVAL

Comments.
/
/
. It has to be ensured that the employee executing the Job has a copy of the permit at all times
during work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
disconnected from the main source of power supply.
Comments

Project
Director
Subcontractor
Site Manager
Doosan Civil/
Architecture
Manager
Doosan Electrical/
Mechanical Manager
Subcontractor Area
Manger
Doosan QA/ QC
Manager
)
Rev. C
Page 9 of 29
Security
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 4
ELECTRICAL WORK PERMIT
Company:
Date:
Description of
Work
PERMIT REQUIRED FOR
Electrical Work
LOCATION:
Section I
PERMIT RECIVER DETAILS
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Valid Till
Extended Date
Valid Till
Extended Time
Valid Till
Section III
PREREQUISITE
(Work will be stopped if one of the following is not complied with)

Details of the 220 volt power tool

1
Type of Power Tool
Reason for using the equipment ;
Drill
Breaker
Others
ELCB Tested and

certified
Industrial Sockets
(Blue) in use
Armoured cable
D
3
4
5
Manufacture
Serial
Number
Electricians Declaration
I_________________ representing _________________ hereby declare that I have checked the
location/machine mentioned above and confirm that it is in line with all safety requirements and is
safe to be used.
F
G
H
I
J
Date :// Name; . Signature ;..

Section IV
Yes
NA
Toolbox talk on use of

220 volt elec.
Equipment is
adequately earthed
Safety Warning Signs
in place
Dead Mans Switch
functioning
Double Insulated
casings
Area of work kept dry
Cables appropriately
protected
PERMIT APPROVAL
Reviewed by Doosan Manager: Signature Date /.../..

Comments.
Rev. C
Page 10 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV

(2 x 600 MW)
PERMIT APPROVAL
/
/
Name of the Doosan EHS Manager:.... Signature Date
/.../..
Comments

Project
Director
Subcontractor
Site Manager
Doosan Civil/
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 11 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 5
NIGHT WORK/ HOLIDAY WORK PERMIT
Company:
Date:
Description of
Work
Night Work
PERMIT REQUIRED FOR

Section I
Holiday Work
LOCATION:
Task
Supervisor/Foreman(SC)
Contact Number
Contact Number
Contact Number
PERMIT VALIDATIONS
Date ____________________
Time ________________
Date ____________________
Time ________________
NO EXTENSION WILL BE GIVEN

ON THIS PERMIT
IN CASE OF NIGHT WORK PERMIT, THE PERMIT SHOULD BE SUBMITTED AND DISCUSSED BEFORE 4 PM. ALL REQUIRED
SAFETY WORK PREPARATION BEFORE 5 PM and IT HAS TO BE CONFIRMED WITH Doosan EHS MANAGER.
IN CASE OF HOLIDAY WORK, THE PERMIT SHOULD BE SUBMITTED AND DISCUSSED AT LEAST ONE DAY BEFORE.
Section III
PREREQUISITE

Yes/No
NA
Sufficient illumination provided?
Are all employees equipped with clear safety glasses?
Is there an ambulance and nurse present?
Attended Briefing
Details of Employees
working in the night/ holiday
Name, Company
Is security notified of the night

work/holiday work?
Are all employees trained emergency
responses?
5
6
8
Planned Equipment For Night
Work/ Holiday Work
I_________________ representing _________________ hereby declare that I have

checked the location and all the employees have been briefed about the emergency
procedure and services associated with this area of excavation
NA
Are additional permit need?
Yes/No
PTW CANCELLED:
Rev. C
By:
Page 12 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV

(2 x 600 MW)
PERMIT APPROVAL

Comments.
/
/
Comments

Project
Director
Subcontractor
Site Manager
Doosan Civil/
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 13 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 6
CONFINED SPACE ENTRY PERMIT
Company:
Date:
ENTRY REQUIRED FOR
PAINTING
FINISHING
HOT WORKS
Others (Specify) ..
Location(s) :
Section I
Contact Number
Contact Number
Safety Adsiror on Site (SC)
Contact Number
Section II
PERMIT VALIDATIONS
Date ____________________
Time ________________
NO EXTENSION WILL BE
PERMIT EXPIRY DETAILS Date ____________________

Time ________________
Permit Contents:
1) Permit to Confined Space Entry (Two copies one for site one for EHS file)
GIVEN ON THIS PERMIT
This permit covers ENTRY ONLY to a confined space.

All work entailed in effecting entry and after entry shall be covered by the appropriate WORK PERMIT.
Section III
PREREQUISITE

Yes/
No
NA
A Atmosphere in the Confined Space Tested?
If so, are the equipments isolated?
B Oxygen level is 19.5% (Should not be less/more)
Is the main source of supply tagged?
C Will the atmosphere be monitored during work?
Has the toolbox talk been given?
D Continuously/Periodically Specify Interval
Air intake system located free from fume?
E Has the space been ventilated before entry?
Preparedness for emergency response?
Work Method Statements submitted?
G Was the space found unacceptable?
Will any Chemicals be used in the space?
H If so, after ventilation was the area retested?
Adequate illumination to carry out the job?
Are there any other equipment running?
Appropriate PPE Provided?
Will any other equipment be used in the space?
Watcher(s) required?
Will ventilation be continued during work? (LEV)
Details of Employee working

in the confined space
Name, Company
Yes/
No
NA
Details of Equipment and/or

Material being used
Section IV
PERMIT APPROVAL
Reviewed by Doosan Manager: Signature Date /.../..

Comments.
Rev. C
Page 14 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section V

(2 x 600 MW)
PERMIT APPROVAL
/
/
Name of the Doosan EHS Manager:.... Signature Date
/.../..
Comments

Project
Director
Subcontractor
Site Manager
Doosan Civil/
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 15 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 7
IONIZING RADIATION WORK PERMIT
Company:
Date:
Location(s)
Section I
Contact Number
Contact Number
Safety Adsior on Site (SC)
Contact Number
Section II
PERMIT VALIDATIONS
Date ____________________
Time ________________

Time ________________
Permit Contents:
1) Permit to Ionizing Radiation Work Permit (Two copies one for site one for EHS file)
4) Information of Location
5) Checklist
Section III
PREREQUISITE

Yes/
No
NA
A Radiation areas barricaded?
Rad. meters checked & calibrated?
B Caution notice posted?
Remote handling equip. checked?
C Radiation area boundaries monitored?
Sealed source container checked?
D Warning lights etc. positioned?
Other Necessary Precautions?
Yes/
No
NA
Detail of Radiation Source

(a) X-ray apparatus (manufacturing year / type ) :
(b) Max tube voltage:
(kv)
(c) Sealed source type:

(d) Strength:
curies
(e) Serial No.:

Section IV
PERMIT APPROVAL

Comments.
Rev. C
Page 16 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV

(2 x 600 MW)
PERMIT APPROVAL
/
/
Comments

Project
Director
Subcontractor
Site Manager
Doosan Civil/
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 17 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 8
WORKING OVER WATER (MARINE) WORK PERMIT
Company:
Date:
Location(s)
Section I
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date ____________________
Time ________________

Time ________________
Permit Contents:
1) Permit to Marine Work Permit (Two copies one for site one for EHS file)
Section III
PREREQUISITE

Yes/
No
NA
H
Life boat with crew standing by?
B Wind/Waves checked?
Fist aid kit available?
C Visibility checked?
Oil/fuel spillage prevention provided?
D Crane operator possesses a valide certificate?
Fire extingushers maintained operable?
E Hoist wire and clam checked?
Search light furnished for emergency?
Sufficient food stocks & drinking water reserved?
Other necessary precautions?
A Approved Work Method Statement attached?
Emergency communication maintained/available?
G Life Jackets available and worn by all crew?
Yes/
No
NA
Special Note.
Section IV
PERMIT APPROVAL

Comments.
Rev. C
Page 18 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV

(2 x 600 MW)
PERMIT APPROVAL
/
/
Comments

Project
Director
Subcontractor
Site Manager
Doosan Civil/
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 19 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 9
DIVING WORK PERMIT
Company:
Date:
Location(s)
Section I
Contact Number
Contact Number
Safety In charge (SC)
Contact Number
Safety Advisor on Site (DHI)
Contact Number
Section II
PERMIT VALIDATIONS
Date ____________________
Time ________________

Time ________________
Permit Contents:
1) Permit to Diving Work Permit (Two copies one for site one for EHS file)
Section III
PREREQUISITE

Yes/
No
NA
A Approved Work Method Statement attached?
Two way communication established and known?
B Wind/Waves checked?
Emergency communication maintained available?
C Velocity and direction of the current confirmed?
Emergency transportation maintained ready?
D In-water Visibility checked?
Operational Compression chamber available?
E Diving equipment checked?
Compressor for respiratory air chcecked?
Respiratory air clean device provided?
G Diving record maintained?
An air flow meter provided and properly

function?
H Diving dresses free of defects?
Watch man (look out) assigned and maintained
Depth guage properly calibrated as required?
Dive Logs available?
Search light furnished for emergency
Stand by Diver dressed?
Life Jackets available and worn by all crew
Yes/
No
NA
Special Note.
Section IV
PERMIT APPROVAL

Comments.
Rev. C
Page 20 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV

(2 x 600 MW)
PERMIT APPROVAL
/
/
Comments

Project
Director
Subcontractor
Site Manager
Doosan Civil/
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 21 of 29
)
Security
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 10
GRATING REMOVAL WORK PERMIT

Company:
Date:
Description of Work
Location:
Section I
Task
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Section III
Valid Till
PREREQUISITE
iu kin tin quyt
(Nu khng tun th mt trong nhng iu sau c th phi dng vic)

A
Appropriate PPE for the job provided?

Trang b bo h lao ng thch hp?
Work area provided with hard barricade to
properly cover the opening
Khu vc lm vic c ro chn cng ph hp
che y l h?
Hot work involved? Permit obtained?
C thc hin hn, ct, mi? C giy php nh
km?
Hole watcher provided and posted on the area.

C ngi gim st b tr ti khu vc lm vic?
Proper Illumination Provided?

C nh sng khi lm vic?
Yes/No
NA
F
Work at heights involved? Harness worn ?

Anchored?
C lm vic trn cao? Dy an ton c b hng?
C mc dy an ton khng?
Access way provided /re-routed and not

obstructed?
L trnh li i c c thit lp khng v c
chng ngi vt khng?
Yes/No
NA
Hand Tethered Tools and equipment secured

and tied off when work at heights?
Dng c v thit b cm tay c buc dy chc
chn khi lm vic trn cao?
Not over stacked / overload grating materials on
the floor?
Vt liu khng c cht ng qu cao/ trng
lng qu ln trn sn?
Additional work permit attached if any?
Others? Please specify?
C giy php lm vic khc khng?
Nu c? Hy ghi c th.
- All grating must be re-installed at the completion of the work task or the end of the shift. No opening shall remain beyond
the end of the shift, unless a new permit is obtained.
Tt c tm sng st phi c lp t li khi hon thnh cng vic hoc cui mi ca lm vic. Khng c tho d cc
tm sn thp nhng khu vc khng c giy php vo cui ca lm vic.
- No opening shall ever be left unguarded. post a hole watch if necessary.
Khng mt l hng no c b st m khng c che chn. Nu cn thit, dng hng ro cnh bo.
- Ensure hooking strap are provided and fitted properly when removing / installing grating.
m bo dy buc cn thn khi tho g gin thao tc/ lp t sn thao tc.
Rev. C
Page 22 of 29
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Note : This permit Applies only to work in the location described .

Ch : Giy php ch p dng cho nhng khu vc c ch nh.
Company Name:
understand the work which is to be carried out and the method of work to be
Nature of Job: .
used to ensure that it is carried out safely .
Tel.No
Email

Section IV
PERMIT APPROVAL

Comments.
/
/
Comments

Project
Director
Doosan Civil/
Doosan Electrical/
Mechanical Manager
Doosan QA/ QC
Manager
Subcontractor
Site Manager
Subcontractor Area
Manger
Security
Rev. C
Page 23 of 29
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 11
ROAD CLOSURE PERMIT

Company:
Date:
Description of Work
Location:
Section I
Task
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time Issued
Valid Till
Section III
of the following is not complied with)
iu kin tin quyt

(Work May be stopped if
PREREQUISITE
(Nu khng tun th mt trong nhng iu sau c th phi dng vic)

Yes/No
NA
Signal man for traffic control is arranged?

Is your Personal Protective Equipment suitable?
Has a detour plan?
Are there hard barricades fenced at working area
to cover the gaps?
Are there hard barricades and warning

signboards?
Do you have to work at height? Has your
Safety ever been damaged? Do you use safety
belt with belt clamp or not?
Has access way for pedestrians?

Is access way built and is there appearance of
obstacles?
Yes/No
Company Name:
Nature of Job: .
used to ensure that it is carried out safely .
Tel.No
Email

Section IV
PERMIT APPROVAL

Comments.
Rev. C
Page 24 of 29
NA
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
/
/
Comments

Project
Director
Doosan Civil/
Doosan Electrical/
Mechanical Manager
Doosan QA/ QC
Manager
Subcontractor
Site Manager
Subcontractor Area
Manger
Security
Rev. C
Page 25 of 29
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 12
WORK PERMIT AT COMMISSIONING ZONE

Company:
Date:
Description of Work
Location(s):
Hot Work
Authorizations
Equip. test / energization
Section I
Confined Space
Live line work
Others
Task
Contact Number
Contact Number
Contact Number
Section II
PERMIT VALIDATIONS
Date issued
Valid Till
Time issued
Valid Till
Section III
Worked Permit Level (Checked by Commissioning Dept.)
Approval
Isolation (No.)
Section IV
Hazard Condition
Hazard Control Implemented (Comments by Commissioning Dept.)
Comments
Section V
Requried PPE and Safety Device (Checked by Commissioning Dept.)
Hearing Protection
Face Shield
Fall protection
Flash suit
Gas Tester
Non entry rescure
Respiration(Type)
Gloves(Type)
Other:
Company Name:
Nature of Job: .
used to ensure that it is carried out safely.
Tel.No
Email

Section - VI
PERMIT APPROVAL
Reviewed by Construction Manager:
Signature
Date .../.../..
Comments
Rev. C
Page 26 of 29
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Reviewed by the EHS Manager:
Signature
Date .../.../
Signature:
Date .../.../..
Comments
Approved by Commissioning Manager:

Comments
Section - VII
WORK COMPLETE (If required)
Isolation certificate No:

Work Permit Holder
Name:
Sign:
Date:
System readied for normal service
Name
Sign:
Date:
Name
Sign
Date:
(Construction Dept./CRE)
All signature verified / Database updated
Work permit controller
Remarks
In case of emergency, please call control room on:___________________________or EHS on: __________________________________
or VT4 First Aid Room on 0623.793.370
Rev. C
Page 27 of 29
EVN GENCO3/VTTPMB
DMPP Consortium

(2 x 600 MW)
Attachment 13
WORK PERMIT FOR HYDRO TEST / PRESURE TEST

Company
Date:
Description of Work
Hydro Test
PERMIT REQUIRED FOR

Section I
Pneumatic Test
Location:
Task
Contact Number
Contact Number
Safety Advisor on Site (DHI)
Contact Number
PERMIT VALIDATIONS
Date ____________________
Upon Completion of above
Time ________________
mentioned Hydro/Pressure Test

Date ____________________
Permit Contents:
1) Maximum Test Pressure:
Time ________________
this permit will be expired.
2) Holding Time:
3) Attach Copy of P&ID, Drawing and highlight the area
(Including Watchman Points, Safety Distance)
Section III
PREREQUISITE

Yes/No
NA
Yes/No
Notification to all departments.
Are watchmen appointed in the area?
Are warning signs in place?
Are Pressure gauges calibrated?
Is the area barricaded from injection and discharge

points?
1
Attended Briefing
Details of Employees
working in the night/
holiday
Name, Company
Is final inspection of the line conducted

and signed off by QC department.
5
Planned Equipment For

Hydro / Pressure Test

have checked the location and all the employees have been briefed about the
emergency procedure.
I will ensure that hydro test/pressure test area is
continuously under monitoring and supervision. No unauthorized person shall be

allowed to go near tested lines/injection or discharge points.
NA
PTW CANCELLED:
Rev. C
By:
Page 28 of 29
EVN GENCO3/VTTPMB
DMPP Consortium
Section IV

(2 x 600 MW)
PERMIT APPROVAL (Construction Department)

Comments.
/
/
during work. No equipment shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be
Comments

Project
Director
Subcontractor
Site Manager
Doosan Civil/
Subcontractor Area
Manger
Doosan Electrical/
Mechanical Manager
(
Doosan QA/ QC
Manager
)
Rev. C
Page 29 of 29
)
Security

VT4 PTW Template

Hochgeladen von

Dokumentinformationen

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

VT4 PTW Template

Hochgeladen von

Copyright:

Verfügbare Formate

EVN GENCO3/VTTPMB

Vinh Tan 4 Thermal Power Plant Project

PERMIT REQUIRED FOR

DETAILS OF THE PERMIT RECIVER (SC = Sub Contractor, DHI = DOOSAN)

Permit Receiver (SC)

Engineer Responsible (DHI)

Safety Advior on Site (SC)

(Not more than a week)

(Work May be stopped if one of the following is not complied with)

for YES and X for No

Flammable Materials removed from location

Appropriate Working Platform

Welding Gensets terminal insulation

Safety/Warning Signs in place

Area of work clean and dry

Condition of the welding cables

Appropriate Fire Extinguisher Provided

Operatives trained in using fire extinguisher

Flash Back arrestors - Gas Cylinders

Fire Blankets (non flammable) Provided

Cylinders Kept in trolley and secured

Fire Watch Personal

Regulators in good condition

Gas test required

Appropriate PPE Provided

Isolation of Equipments required

Declaration by the Permit Receiver

Name and address of Permit Receiver

I_________________ representing _________________ hereby declare that I

Contact Number (Site Safety Rep)..

DOC. NO. VT4-VA08-P0ZEN-7500033

Vinh Tan 4 Thermal Power Plant Project

Reviewed by Doosan Manager: Signature Date .../.../..

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

DOC. NO. VT4-VA08-P0ZEN-7500033

Vinh Tan 4 Thermal Power Plant Project

PERMIT REQUIRED FOR

Engineer Responsible (DHI)

Safety Advisor on Site (SC)

Section II (Eng. Responsible)

PERMIT ISSUE DETAILS

NO EXTENSION WILL BE GIVEN

PERMIT EXPIRY DETAILS

ALL EXCAVATIONS IN EXCESS OF 1.2M DEEP SHOULD BE APPROVED THIS PERMIT.

for YES and X for No

for YES and X for No

Is the Work Area Clearly Defined? Have the Latest DOC

Has the Area been Checked Underground Utilities?

Are All Service Locations Clearly Marked?

Have All necessary Trial Trenches been Excavated?

Has a Risk Assessment been Completed for the Task of

Are the Required Controls in Place as per the Risk

Details of Employees working

Services indicated by walk through with

Water / Sewer / Irrigation / Drainage

Electrical 11 Kv or Higher Voltage

Electrical Lower than 11 Kv (1m Exclusion)

Telecommunication (1m Exclusion)

Oil/Gas (10m Exclusion)

Overhead Services (Contact Service owner)

Other (including Structures)

Declaration by the Permit Receiver (SC)

I_________________ representing _________________ hereby declare that I have

DOC. NO. VT4-VA08-P0ZEN-7500033

I_ representing _ hereby declare that I

I_ representing _ hereby declare that I have

I_ representing _ hereby declare that I