Permit to Work Inspection Checklist

SBIKHA TK2 REVAMPING

Site/Installation: Date of Inspection:

SBIKHA GAS COMPRESSION STATION 26/10/2023

Area /Unit: Inspectors:

SBIKHA COMPRESSION STATION/ TK02 Chokri Abdejelil

Permit No. Date of Issue:

557/HSE/23 12/11/2023

Issue Time: Valid Until:

06:00 AM 19/11/2023

Name of Permit Holder: Contractor:

Aymen BELHADJ CELGAS

:
Description of Work

Welding & Cutting Activities in the WORKSHOP

Distribution and display

a) Have permit copies been properly distributed, and is the permit prominently displayed at the work ✘ Yes No
site?
b) Is the control room/office electronic copy readily available? Yes No ✘ N/A

Scope
a) Does the permit adequately describe the work? (i.e work location, the equipment to be worked on, ✘ Yes No
the work method and the tools and equipment to be used?)
✘ Yes No
b) Does the Permit cover the scope of work being done and all hazardous activities involved?
✘ Yes No
c) Is the work location clearly described and match with actual work place?
d) Do the work description and isolations clearly specify the limits of the work area and equipment to ✘ Yes ✘ No
be worked on?
If not, state deficiency:

e) Are associated certificates attached? ✘ Yes No N/A

Validity
a) Does the permit clearly state the time and dates between which it is valid? ✘ Yes No
b) Is permit revalidation being signed and dated by Permit Issuer and Permit Holder at the beginning of each ✘ Yes No N/A
shift?

c) Are revalidations up to date? ✘ Yes No N/A

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Hazards
a) Are associated hazards clearly identified on the permit? Yes ✘ No
b) Are Line of Fire hazards clearly highlighted and specific to the task in hand? Yes No ✘ N/A
c) Is HV or LV electricity to be isolated? ✘ Yes No
d) Are they directly applicable to job being undertaken? ✘ Yes No

Health Hazards
a) Was the HRA checked when planning the work? ✘ Yes No
b) Are the health hazards identified on the permit? ✘ Yes No
c) Is appropriate PPE used by the workers? (Including additional PPE mentioned in RA/JHA) ✘ Yes No

Environmental Hazards
a) Is there venting of hydrocarbons or toxic/smelly vapors? ✘ Yes No
b) Is there release of contaminated water to the drains or groundwater? Yes ✘ No
c) Are there any hazardous wastes for disposal? Is hazardous waste properly segregated, packed and labeled? ✘ Yes No N/A

Precautions
a) Are appropriate precautions identified and specific enough for each of the hazards identified? ✘ Yes No
b) Have other affected personnel outside the permit area been notified of the permit work? ✘ Yes No
c) Have all precautions been implemented at the worksite and maintained during the work duration? ✘ Yes No
If not, state deficiency:

Gas Tests
a) Have gas tests been undertaken at the frequency specified on the PTW? Is frequency specified? Yes No ✘ N/A
b) Are tests still valid? Yes No ✘ N/A
c) Are portable gas monitors fully operable at worksite and calibrated? Yes No ✘ N/A
d) Are on-site personnel competent to operate gas monitors? Yes No ✘ N/A

Isolation
a) Are isolation certificates attached to the permit? Yes No ✘ N/A
b) Are they cross-referenced showing to which PTW they refer to? Yes No ✘ N/A
c) Do certificates or attachments detail specific isolation points, method and equipment affected by isolation? Yes No ✘ N/A
d) Are all isolations locked? Yes No ✘ N/A
e) Are all isolations tagged? Yes No ✘ N/A
f) Has the Isolation been verified, and equipment proved safe to work on, including ensuring there is no Yes No ✘ N/A
residual energy?
g) If more than one job requiring same isolation, does each job have own Isolation Certificate and has Yes No ✘ N/A
multiple lock/key system or other suitable control been used?
If so, give details:

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Actions Taken by Permit Issuer

a) Has task been fully discussed with person carrying out the isolation? ✘ Yes No ✘ N/A
b) Has task been discussed with Permit Holder? ✘ Yes No
c) If more than one Permit on equipment/system, have all appropriate cross-references been made and all ✘ Yes No N/A
necessary personnel been made aware?
d) Where tasks may impinge on other responsible persons/areas, have affected persons signed to Yes ✘ No N/A
acknowledge their awareness of the work?

Actions Taken by Permit Holder

a) Has Permit Holder briefed everyone in the Work Party about the hazards and PTW requirements before ✘ Yes No
starting work?
b) Has Last Minute Risk Assessment been conducted before start of work (e.g. Contractor’s LMRA)? ✘ Yes No

c) Has Last Minute Risk Assessment been properly recorded (e.g. Contractor’s LMRA Card signed off by all ✘ Yes No N/A
workers involved)?
d) Do all persons fully understand the safety requirements and the precautions stated on the PTW? Interview ✘ Yes No
workers on specific hazards and control measures
e) Are all involved workers’ name and signature listed on the Permit? ✘ Yes No
f) Are they complying, e.g. using safety clothing as specified, isolating equipment at breaks, etc? ✘ Yes No
If no, specify:
g) Is Permit holder on site able to supervise the work effectively? ✘ Yes No
If no, specify:

Simultaneous Operations
a) Is there any other work at the same location/same equipment or system? ✘ Yes No

b) If your answer above is YES, is there any conflict between the activities? ✘ Yes No N/A

Emergency preparedness
a) Do workers knows where to go in case of emergency? ✘ Yes No

b) Is the escape way to Muster Point available/not obstructed? ✘ Yes No

c) Do workers know the location of the nearest alarm, eyewash, safety shower, first aid kit, AED device? ✘ Yes No
d) Are adequate fire extinguisher / fire hoses available? Easily accessible and charged? ✘ Yes No
e) Are safety Shower and eye wash station free from obstruction? ✘ Yes No
f) Is adequate/clean water available at safety shower and eye wash station? ✘ Yes No

Handover
a) Was handover of permit done between Permit Issuers and Permit Holders at shift change by signing off and Yes No ✘ N/A
signing on again the PTW?

b) Is there a handover meeting held and documented stating work progress, changes and any other Yes No ✘ N/A
information needed for safe execution of work scope?
c) How has the oncoming shift checked the work? Yes No ✘ N/A
d) Has there been a handover of jobs between Permit Holders? Yes No ✘ N/A

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Work Suspended/Completed
a) Has site and any equipment been left in a safe and tidy condition? ✘ Yes No N/A
b) If work not complete, are isolations secure? ✘ Yes No N/A
c) Are the Permit Issuer and Control Room operators aware of status? ✘ Yes No N/A
d) Has the permit been correctly signed off? ✘ Yes No N/A

Competence
a) Have the signatories and others received classroom and practical training in the company's PTW system? ✘ Yes No
b) Is the type and frequency of training in accordance with company policy? ✘ Yes No
c) Have the signatories been assessed as competent? Check records. ✘ Yes No
d) Have the signatories been formally appointed? Check Records. ✘ Yes No
e) Are the appointments still valid? ✘ Yes No N/A
f) If working in Confined space, have all workers received Confined space training? Yes No ✘ N/A
g) If Applicable, has the Standby person or Fire watch received training for their specific Task? ✘ Yes No N/A

Summarize Overall Inspection

Highlights:

The operation was very managed: all the associated hazards and identified potential risks were
communicated to all personnel, most the suggested precautions on both PTW and JSA were implemented,
SIMOPS with other company (performing civil activities on the area under our working spot) was considered,
it was agreed to postpone the other company activities.

The PTW and attached documents were very understood by all the involved parties.

Lowlights:

No Toe Bord was installed with the guard rail system on the roof as required by the JSA.

Inspectors Signature Chokri Abdejelil

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