WORK PERMIT

LEVEL 2 LEVEL 1

NO.:

Well operation Work on hydroExplosives carbon system Critical lifting operation Other/critical operation

Area (sketch/description)

Hot work A Hot work B Entry (confined space) Isolation of safety system

Pressure testing Work above sea Dangerous substances Radioactive materials

Work level 2 SAFE JOB ANALYSIS: NO: REQUIRES APPROVAL FROM ELECTRICAL DEPARTMENT
WORK ORDER NO.: OPERATION NO.: ISOLATION NO.:

Applicant name: Work description:

Discipline:

Phone:

Day
Equipment/tools: : Installation: Tag/line no.: Attachment:: Location/modul: Deck: Zone: Date:

Night
From hr:

Ongoing work To hr:

Sign: Sign: Sign:

Extended to hr: Area/Operations Supervisor CCR Technician Area Technician

OPERATIONS- AND SAFETY PREPARATIONS

Required Performed by area technician Depressurization Draining/emptying Cleaning/gasfreeing Isolation by singel valve/double block&bleed Isolation by blind/Isolation plan Safety tag/lock Venting/Extra ventilation Prevent release of oil/gas in the area Measures against radioactive radiation Inspection of the area every hour Other

A
Signature

B
Required Performed by executing skilled worker Portable gasdetector no. on the worksite Verify mechanical isolation Electrical isolation/locking Tag. No.: Fire Extinguisher/fire prevention Welding machine safely located and earthed Continuous guard/radio communication Drains blocked/covered Barrier/warning sign/PA-announcement Cooperate with CCR/Area technician Follow requirements for work above sea/at height Chemical data sheet known and available Procedures/cheklist for the operation known Ref. No. : Control of temporary lifting equipment Follow requirements for Entry (confined space) Special personal protective equipment

Signature

GASMEASUREMENTS PRIOR TO/DURING THE WORK Hydrocarbons every hour H2S every Oxygen every hour every ISOLATION SAFETY SYSTEM System:

hour hour

Locally

CCR

Measures to avoid work related deseases

Location/area: Compensating measures:

Other requirements/preparations

APPROVAL/AUTHORIZATION

Area/Operations Supervisor: Remarks/requirements:

Other position:

HSE Function:

Platform manager:

PRECAUTIONS PRIOR TO / DURING WORK EXECUTION

Safety system isolated/reactivated Isolated locally/CCR Reinstated locally/CCR Remark: Signature:

B
Gastest - value HC O2 H2S Time/sign.

4
Work site cleared according to requirements Area Technician time: Signature: The work is cleared with CCR CCR Technician time: Signature:

Precautions understood and are/will be fulfilled

Executing skilled worker

Name: (Block letters)

COMPLETION

A Yes No Yes No Signature:

Signature:

B Work completed Work not completed Work place cleaned and secured Executing skilled worker Signature: Original: Work site Copy:
GR0216803_01_eng

All locks/tags removed Equipment ready for operation Area Technician time: Work cleared by CCR CCR Technician time: