BEFORE YOU WORK ON EQUIPMENT OR SYSTEM - ISOLATE, LOCK, TAG AND PROVE THAT IT IS DEAD

MARAFIQ-SAUR OPERATION & MAINTENANCE COMPANY

ISOLATION CERTIFICATE
This isolation Certificate is to be kept in LOB and copies are to be attached to PTWCs. No.
Section 1 PTWCs: Please write below serial numbers of PTWCs which are interacting with regards to isolation points and issued to
non operational works either on same or different system / equipment with common isolation points.
1 2 3
Permit to Work Certificate #
4 5 6
SYSTEM : LOCATION:
LOCK OUT BOX No : EQUIPMENT:
Section 2: ISOLATION POINTS Section 3: ISOLATION Section 4: DE-ISOLATION
Description of Identification no. of Required status Applied by API or his Nominee Removed by
Required status on
Sr. isolation point / isolation point (same as no. before issuing (API or his Nominee)
completion of job
equipment on the tag applied) PTWC Name Signature Name & Signature

I certify that above isolations are applied I certify that above isolations are
CERTIFICATION effectively and system/ equipment are removed, and system / equipment is in
rendered safe to work on. safe operational condition.
Name of API
Signature
Date and Time

*After isolating the system / equipment, Authorized Permit Issuer (API) shall keep original Isolation Certificate in the Lock Out Box
and shall issue 1. a copy of Isolation Certificate, 2. one Lock Out Box key and 3. Permit to Work Certificate (PTWC) to each Authorized
Permit Receiver (APR) for carrying out non operational work.*
N.B. Following terms abbreviations must be clearly written regarding status of isolation in the column:
Switched On S/On Valve Closed C Drained D Vented V
Switched Off S/Off Valve Opened O Purged P
Blinded B
Lock Applied L Racked In RI Earthing Applied EA
Unlocked UL Racked Out RO Earthing Removed ER Flushed F

Tag Applied Red / Blue / Yellow TAR TAB TAY Tag Removed Red / Blue / Yellow TRR TRB TRY
02/05/2013
 SAFE ISOLATION GUIDELINES
ALL EQUIPMENT OR SYSTEM ON WHICH NON OPERATIONAL WORKS ARE TO BE PERFORMED, SHOULD
BE ISOLATED EFFECTIVELY.
1 All isolations and de-isolations shall be carried out safely by API (Authorized Permit Issuer) or his nominee
i. According to approved Operation department Isolation procedures or switching programs
ii. Wearing required appropriate personal protective equipment (PPE) to protect from adverse effects of all sources of energy

including electric shock and arc flash hazard burn injuries

iii. Taking all necessary safety precautions including emergency arrangements.

iv. Identifying by posting an isolation red tag and

v. Using right safe tools and work equipment

2 Prior to issue of PTWC for permitting any non operational work on any system / equipment, the system or equipment should be:

i. Effectively isolated – disconnected and separated from all sources of energy – electrical, mechanical, chemical, thermal,

steam, including spring, mechanisms, pneumatic and hydraulic systems, etc, to prevent the inadvertent operation of system or

equipment or the release of stored energy

ii. Proven dead for effectiveness - examples: i. Using multi tester for electrical equipment or ii. Ensuring no water is passing

through isolated valves

iii. Secured with a padlock and chain (where required – example for valve wheels / spindles) . Main suction & delivery valves,

electrical breakers must be locked.

iv. Identified by applying an isolation red tag on the equipment or system

Electrical equipment/ system shall be isolated from low voltage to high voltage

Prior to allowing any work on an electrical breaker, its incoming power supply must be isolated
Mechanical equipment shall be depressurized, drained, vented , purged, blinded, or provided with thrust block, etc as required

3. Isolations should be maintained in tact with locks and tags throughout the duration of non operational works.

4. No one should interfere or tamper with any isolation that are applied on the system or equipment and certified in

isolation certificate

5. API shall record all isolation points in the Isolation Certificate in sequential order.

All isolations that are carried out on one electrical system by Operations department and High Voltage
Electrical APIs should be recorded in only one Isolation Certificate by Operations API

6. API shall write clearly isolation point description, identification number, status of isolation required in respective
columns.
7. After isolating equipment / system , API or his nominee whoever is isolating, should sign in the column applied by
and isolation certificate should be certified by API himself
8. API shall prepare only one Isolation Certificate for all Permit to Work Certificates (PTWC) that are issued to work
on the same system / equipment or more having common isolation points.
9. API shall keep original isolation Certificate with the isolation point padlock keys in the Lock Out Box (LOB) .
10. API shall issue copies of isolation certificate + LOB key to each APR (Authorized Permit Receiver)working on the
same system or equipment or on different systent systems with common isolation points, along with PTWC
11. APR shall verify the isolations are correctly applied and effective, prior to receiving PTWC & Isolation Certificate
and conducting nonoperational work
12. API or his nominee shall restore isolations (de-isolate) after completion of non operational work when safe to do so.