all signatures are required prior to hot work start. authorized print namesignaturedate permit...

All Signatures are Required PRIOR to Hot Work Start.

Authorized Print Name Signature Date

Permit Holder

Permit Issuer

Chief Operator

Fire Watch

Job Hazards Y Standard Controls Job Hazards Y Standard Controls PPE Req’d

Access & Egress Housekeeping, Walkways, Stairs Manual Handling Assessment ,& Equipment Standard (SSP-0011) YActivities of Others Communications, Barriers, Permit Moving Parts Covers, Isolation, & Maintenance Full Face Shield Adverse Weather Stop Work & Take Refuge Noise Insulation, Hearing Protection, & PPE GogglesChemical Exposure MSDS Review, PPE Overhead Cables Labelling, Isolation, & Barriers Hearing ProtectionVehicle Entry Procedures, Barriers, & Permit Sharp Edges Covers, PPE, & Equipment Inspections Fall ProtectionElectricity Isolation, LOTO Slips, Trips & Falls Housekeeping, PPE Chemical Gloves Exposure to Fuels PPE Static Electricity Grounding, Chemical Suit Fatigue Rest Periods, Refreshments Trapped Pressure Venting, Draining, & PPE Respirator ½ faceFire & Explosion Gas Testing & Isolation Vehicle Traffic Hi-Vis Clothing, Speed Limit, & Signs Respirator Full FaceFumes & Dust Filter Mask, Eye Protection Underground Cables CAT Testing, Labelling, & Barriers Air Supplied Hood/LineSoil/Water Contamination Isolation Hot Liquid Procedures & PPE SCBASecondary Containment Procedures Working at Height Hand Rails, Harness, & Life-Line Personal H2S Monitor YHot Surfaces Procedures & PPE Working Over Water Life Jacket, & Safety Boat, Other..Nature (insects, snakes…) Awareness, Remove, PPE Inside Falling Material Scaling walls, shoring up, securing

Meraux Refinery Hot Work PermitPermit Number:

Information to be completed by Permit Holder

Company: Meraux Refinery Contractor Name

Area/Unit Permit Holder: Date:

Equipment # # Persons:Work Order # (s)

Scope of Proposed Task:

Information to be completed by Permit Issuer.

Work Description:

Previous Product in Vessel:

MSDS Checked Yes No Comment:

Equipment Pre-Work Req’d Done Equipment Pre-Work Req’d Done Area Preparation Req’d DoneLOTO Procedures Followed Lock Box Number: Trained Fire Watch Y• Valves-Closed/Tagged/Chained/Locked • Orange Vest Y• Equipment Opened/Depressurized Equipment Decontamination • Signal Horn Y• Blinded/Disconnected • Water Washed • Fire Extinguisher Y• Electrically locked / tagged out • N2 Purged Area “Wet Down”

• Field Test / Attempt to Energize-start • Steamed Contained SparksBlinds Verified & Blind-List initialed Lighting Sumps-Drains Covered

• 120 V w/ GFCI Clean-up oil in areaAdditional Fire Equipment

No Date Time %LEL Oxygen H2S CO Other Serial No Meraux Qualified Person:1

2

3

4

Additional Controls Required: Special Instructions:

All Signatures are Required PRIOR to EXTENDING permit up to 12 hours.

Authorized Print Name Signature Date

Permit Holder

Permit Issuer

Chief Operator

Fire Watch

Permit End Work CompletedWork Site in

Safe Condition Print Name Signature Date

Permit Holder Yes No Yes No

Unit Operator Yes No Yes No

Signing this Work Permit signifies the job site has been inspected by the Permit Issuer and Permit Holder, the area is prepared, and each individual has agreed to comply with the conditions of this confined space permit. The Permit is valid for a period of up to 12 hours or may be extended (below) for up to 24 hours.