BI# 10-00875

Relocate Jazan-Abha Refined Products Pipeline SICIM SAUDI ARABIA

Contract # 6600045122
HOT WORK PERMIT WORK PERMIT NO #

Month Day Year Duration

Section-1 – Work Description

Identify Plant/Facility (where work will be carried out)

Exact work location

Work Description

Equipment to be used at site

STOP WORK if job site does not meet work permit conditions or any applicable Saudi Aramco Safety & Health requirements at any time
Section 2 – Hazard Identification and Control
A. Identify and attach any supplementary forms required to perform/control the work
 Method Statement  Critical Lift Plan  Pre-Excavation Checklist  Excavation Checklist  Job Safety Analysis
B. Energy Types
 Electrical  Mechanical  Hydraulic/Pneumatic  Hydrocarbons  Others
C. Potential Exposures
 High Noise  Temperature  Hydrogen Sulfide(H2S)  High Wind  Hazardous Material
 Radioactive Material  Flammable Liquids/gasses  Others
D. Protective Equipment
 FRC Clothing  Fall Protection  Personal H2S Monitor  Goggles/Face  Hard Hat 
shield
 Safety Shoes  Barricades  Respiratory  Warning Signage’s  
Protection
 Standby Man  Firewatcher  Flagman  Confined Space Entry Supervisor
Badge# Badge# Badge# Badge#
E. List any additional safety requirements

IN CASE OF EMERGENCY :

Section 3 – HAZARD ANALYSIS CHECKLIST

Y N N/A Y N N/A
Is the correct type of permit issued for the work    Are slip trip and fall hazards controlled   
Are weather conditions(wind speed , temperature) Have all the requirements of work at height
     
acceptable to perform the work been applied
Does the crew know what to do in case of Are all ignition sources eliminated or
     
emergency controlled
Does personnel have proper certifications to Is the scaffold tag completed correctly, signed
     
perform activity/equipment/device and with a valid inspection date
Is the equipment’s inspection sticker valid    Is the correct PPE available for the personnel   
Does the work crew have the correct Does the fire watch have firefighting
tools/equipment for the job? are they in good    equipment available and know how to use the   
condition equipment

Section 4 – Gas Testing/Monitoring

LEL (%) H2S (ppm) O2 (%) GAS TESTER NAME CERTIFICATE No. SIGNATURE
Initial Test

Additional

Section 5 – Permit Authorization & Closure

PERMIT RECEIVER PERMIT ISSUER
PERMIT BADGE No. CERTIFICATE No. SIGNATURE BADGE No. CERTIFICATE No. SIGNATURE
OPEN
HSE AUTHORIZATION & Name Signature Work shall not start without HSE authorization, Permit shall be
VERIFICATION considered void without approval of HSE Dept.
I have inspected the work site and confirm that it
This permit has closed Date Time
has been returned to a safe condition
CLOSED
JAPL-F-HWP-002 (Rev. 01)