Authorization No.

: BRAU-CLD1701124

BHARAT OMAN REFINERIES LTD.

BINA, M.P , 470124

Authorization for COLD WORK

COLD JOB VESSEL BOX UP WORK AT HEIGHT RADIOGRAPHY

CONTACT NUMBERS : FIRECALL : 6666 AMBULANCE / OHC / MEDICALCENTRE : 6111

WEEKLY QUARTERLY MONTHLY

JOB DETAILS & AUTHORIZATION

ISSUER DEPT/SECTION: Process EXECUTOR DEPT/SECTION: Project & Engineering Services

1. PERMISSION GRANTED TO : VIKHYAT PUSHPAD,PRIYANK DAVE

2. DESCRIPTION OF WORK : Erection /dismantling of scaffolding
(Nature of Work & Tools/Equipments to be Scaffolding Erection \ Dismantling
used)
3. LOCATION OF WORK & EQUIPMENT TAG : MSB Area
NO.
4. FIRE ZONE/AREA : A2 - MSB
5. NAME OF CONTRACTOR & CODE NO. : M/S MADHAV INFRA PROJECTS LIMITED (105649)
6. VALID FROM : 04/04/2017 10:30 Hrs
7. VALID TO : 11/04/2017 23:00 Hrs
CONDITIONS TO BE ADHERED TO FOR COLD REQD NOT- CONDITIONS TO BE ADHERED TO FOR COLD REQD NOT-
JOBS (ROLE OF ISSUER) REQD JOBS (ROLE OF EXECUTOR) REQD
1. Checking of 11. Area
Equipment Work Area
Covered Cordoned off Display of caution
boards Tags provided
2. Surrounding area 12. Mean of access provided i.e.
Cleaning Checking
Ladder Scaffolding (BORL Std.) Man basket
Bosun chair Crawling board
3. Equipment 13. Fire water hose with
Electrically isolated Tagged
Fog nozzle Steam Lance Portable DCP fire
extinguisher at work site
4. Equipment 14. Display of contractors work execution board at site
Blinded Disconnected Closed Isolated
Wedged open Wagged
5. Equipment properly 15. Alternate means of escape/exit available
Drained Depressurised
6. Equipment properly 16. Precautions against falling of material in work area
Steamed Purged Water flushed
7. Gas test 17. Proper ventilation at site
HC O2 H2S CO SO2 Other,if
any
8. Cross reference of related Authorization 18. Proper lighting at site
9. Considered hazard from other routineon routine 19. Iron Sulphide
operations and concerned persons alerted
Removed Kept wet
10. Standby personnel provided from
Issuer Dept. Executor Dept. Contractor
Fire stn. (for fire watch)
20. Risk Assessment (RA) by
Issuer Executor

REQD NOT
CONDITIONS TO BE ADHERED FOR WORKING AT HEIGHT
REQD
1. Checking of

Equipment Surrounding Area

2. Provided

Area cordoned off Covering of floor openings Display of caution boards Tags
3. Means of access provided i.e.

Ladder Scaffolding (BORL Std.) Man basket Bosun chair Crawling board
4. Precautions against falling of material in work area and material carried up at elevation are fall protected

04/04/2017 12:31:27 PM---VIKHYAT PUSHPAD---Page 1

 Authorization No.: BRAU-CLD1701124
REQD NOT
CONDITIONS TO BE ADHERED FOR WORKING AT HEIGHT
REQD
5. Standby personnel provided from

Issuer Executor Project Contractor Fire Station

6. Provision of

Roof ladder Crawling board

7. Scaffolding erected as per BORL Standard, inspected and display of safe to use board at site

8. Provision of Safety net at site (As per nature of job and RA prepared by Executing Agency)

9. Provision of Fall arrestor at site (As per nature of job and RA prepared by Executing Agency)

10. Alternate means of escape / exit available at work site (fixed ladder with 1 meter projection, platform without any obstructions)

11. Considered hazard from routine / non routine operations and concerned persons alerted

12. Proper lighting provided at work site. Provision of ELCB (Earth Leakage Circuit Breaker) for use of portable tools / equiments being
used at work site
13. Proper ventilation provided at work site

14. Power lines / HT lines are not in the close proximity of work area or isolated / disconneted

15. Cross reference of related Authorization / Work Permit

16. Gas Test

HC O2 H2S CO SO2 Other,if any

17. Risk Assessment (RA) by

Issuer Executor

USE OF PERSONNEL PROTECTIVE EQUIPMENT

1. Following personal protective equipments (PPEs) are to be used

Safety helmet Gloves Goggles Safety shoes Boiler suit Fresh air mask PVC apron
Lifeline Ear plug Face shield Dust mask Breathing apparatus Double lanyard safety belt
Additional Precautions(If Any)

No Precautions Available

Remarks(If Any)
Sr. Authority Person Name Remark
No.

No Remarks Available

Authorization References(If Any) Approval Cycle

Auth. Serial No. Authority Person Name Approval Date
No Referenced Authorizations Creator VIKHYAT PUSHPAD 04/04/2017 10:03 Hrs
GSI OM PRAKASH SINGH 04/04/2017 10:14 Hrs
AcceptedBy VIKHYAT PUSHPAD 04/04/2017 12:31 Hrs

Signature by BORL executor _____________

04/04/2017 12:31:27 PM---VIKHYAT PUSHPAD---Page 2

 EXECUTORRA
Sr.No HazardIdentification ControlMeasures ContingencyPlan
Whatcangowrong ForeachIdentified Actionincaseof
Hazard Emergency
1 Sliphazard ProperHouse InformSIC,Executor,
Keeping.Asperjob AE
onlyrequired
manpower,tools,
materialtobekept
atjoblocation.
2 PersonInjury Workplacetobe InformSIC,Executor,
barricaded. AE
3 PersonInjury WearSafetybelt InformSIC,Executor,
above1.8mheight. AE
4 PersonInjury Scaffoldingpipeand InformSIC,Executor,
ClampsasperBORL AE
standard.
5 PersonInjury Pipeshouldbe InformSIC,Executor,
shiftedHandtoHand AE
andnotinbulk.
Clampshouldbe
shiftedinbucket.
6 PersonInjury Scaffoldingshouldbe InformSIC,Executor,
certified. AE
PreparedBy:VIKHYATPUSHPAD1823 ApprovedBy:ManeeshKumarSharma1075