PERMIT TO WORK – PRESSURE TESTING

HAMAD MEDICAL CITY PROJECT

Pressure Testing Pressure Testing Other

Location (Building & Floor): ………………………
(Hydro) (Gas) test

Permit No. _________________________ Date : __________________ Max bar Pressure

for this test:

Section – I DETAILS OF THE PERMIT RECEIVER

Name of company
Name of Permit Receiver Contact Number
Name of Engineer (in charge) Contact Number
HSE STAFF (in charge) Contact Number

This permit is valid only for one (1) day. If needed, this should be renewed on the Second (2nd) day WITHOUT FAIL

Section – II PREREQUISITE (Work May be stopped if anyone of the following is not complied with)
 : YES - X : No Yes NA  : YES - X : No Yes NA
Are safety warning and pressure
Is the test carried out in accordance with approved Method
A G testing signages in place ?
Statement and Risk Assessment?

Position of Valves physically checked – whether Open or Availability of bucket or containers to

B H
closed as per requirements collect water?
Removed /protected all electrical equipments or other Valid Calibration certificates
C I
materials from the place of possible leakages available for Pressure Gauge
D Possible leakage points barricaded J Close supervision available

E All joints/ plug / coupling / Flanges physically checked? K Isolation of Equipments required
Are the operatives trained for PRESSURE Testing and Close watch out are positioned
F L
task briefing delivered to operatives? where required
Section III PERMIT APPROVAL

Work shall be carried out ONLY after complying with the precautions given in Section – II of this Permit. I certify that the above
location has been examined, the precautions adopted as per the Required Precautions Checklist in order to prevent any possible
incident/accident and permission is authorized for this test.
Name & Signature Name& Signature Name & Signature
Originator(SUBCONTRACTOR) MECHANICAL Construction Dept (HDEC) HDEC HSE Dept

Section – IV PERMIT VALIDATIONS (To be filled by HDEC HSE Officer Only)

Date & Time issued Valid until what time (Not beyond 0001 hrs)
Extended Date &Time Valid until which date (Not more than a day )

On completion of day’s job (Permit closure)

I have thoroughly checked physically and confirm that proper measures are taken (including housekeeping), leaving behind
the area safe, hence closing this Work Permit.
Name & Signature Name& Signature Name & Signature
Originator(SUBCONTRACTOR) MECHANICAL Construction Dept (HDEC) HDEC HSE Dept

WORK COMPLETION & PERMIT CLOSING OUT DATE AND TIME : …………………………………………………..

Note : After obtaining approval on the ‘Work Notification’ from HDEC, this permit must be displayed at site by the concerned Sub-contractor prior to
taking up of any pressure test activity in the approved area. Copy of the Approved Permit must be retained with the site safety officer and must be
produced to Inspectors on demand.

HDEC/HSE/F0047/Permit to work - Pressure test Rev. 00 Page1 of 1