Pressure Test Permit

Sched Date Hours Location Permit Requested by Work to be done

From

To
Part 2 - Condition of the Pressure Test Work Area Yes No N/A Comments

1 Are Method Statement/TRA available on site?

2 Is pressure testing carried out using water?

Is test equipment in sound condition properl) fitted and of the correct pressure
3
rating for the job?
Are safety valves of adequate size and properly set, installed in the test supply line
4
to prevent the test pressure from being exceeded?

5 Are calibrated pressure gauges fitted to equipment under test?

Are controls/gauges at a safe distance from the equipment to be tested and gauges
6
clearly visible tothe operator controlling the pressure?

7 Is the area cordoned of to prevent unauthorised entry and warning signs posted?

8 Are look-out personnel posted to patrol the area?

9 Has the correct test pressure been identified?

10 Is proper leak detection being performed i.e. visually, soap test?

Are all fittings protected with a shield to prevent injury to personnel in case
11
of failure?
Part 3 - Preparation before entry Yes No N/A Comments
1 Is TBM conducted among the crew by the supervisor and is recorded?
2 Is proper PPE worn properly before entry like welding mask or face shield,
welding/cutting gloves, Safety Shoes, helmets, welding apparrel, etc?
3 Others:

Authorization

Signature of EHS Department Time Date

Received by

I have read this form and understood all stated above and will comply to all needed precautions before work
starts. I will be responsible for any incident/accident due to my negligence in following this permit

Signature of Engineer/Foreman In-charge Time Date

Cancellation
All copies of this permit are hereby cancelled

Signature of HSE Department Time Date

Notes:
This form shall be given back to the HSE Department after the specified time and date of finish.
This form is good for the specified time and date only
This form is not transferable to the next shift and is valid for 1 shift only.

EHS-39 Rev 00 / ISSUE-01