HOT WORK PERMIT CHECK LIST

Company Forms and Check Lists

Date : 03.04.01 Rev.No : 1 Prep. : MGV App. : CAP Section : 02 Page : 1 of 2

This permit relates to any work involving temperature conditions which are likely to be of sufficient intensity to cause ignition of combustible gases, vapours of liquids in, or adjacent to, the area involved. This permit is valid From To Location of hot work Has enclosed space entry permit been issued? Please advise reason if "NO" Description of hot work Personnel carrying out hot work Responsible person for hot work Responsible person for safety 1 Has the work area been checked with a combustible gas indicator for hydrocarbon vapours? Has the surrounding area been made safe? 2 Has the work area been checked with combustible gas indicator for hydrocarbon vapors? Has the equipment or pipeline been gas freed? Has the equipment or pipeline been blanked? Is this equipment or pipeline free of liquid? Is the surrounding area safe? Is additional fire protectin available? Is the equipment isolated electrically? Special condition/precautions Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Time: Yes / No Time: hours hours Date Date

X:\SHIP\IMO_ISM\FORMS\COMMON\EMERGENC\HOTWORK.SAM

MT LADON

HOT WORK PERMIT CHECK LIST

Company Forms and Check Lists

Date : 03.04.01 Rev.No : 1 Prep. : MGV App. : CAP Section : 02 Page : 2 of 2

In the circumstances noted it is considered safe to proceed with this work Signed: ________________________________ Master ________________________________ Person in charge of work team 3 The work has been completed and all persons under my supervision, materials and equipment have been withdrawn. Authorised officer in charge: _______________________ Time: ____________________________________ Date: ___________________

General
First copy for display at work area Second copy for ship's records Starting/finishing time must not exceed the Authorised Signatories'/Responsible Officer's working hours. Specific location of hot work to be given. Description of work to include type of equipment used.

Section 1
Applies to all hazardous work not involving naked flame or continuous spark production, and would include use of electrical equipment, use of air driven rotary equipment, sand or grit blasting, hammering and mechanical chipping and movement of equipment/materials over or near to machinery that is operating.

Section 2
Applies to all hot work involving high temperatures, open flame, or continuous source of sparks, etc. This type of work includes but is not limited to: Welding or burning Grinding Sand or grit blasting Metal chipping Tests for combustible gas should be carried out immediately before commencement of hot work and at frequent intervals.

INSTRUCTIONS :
To be filled in avery time hot work shall be undertaken. To be filed in the Safety Officer's file Section 5 and kept for a period of three years.

X:\SHIP\IMO_ISM\FORMS\COMMON\EMERGENC\HOTWORK.SAM

MT LADON