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ALANGHSE SERVICES		 COLD WORK PERMIT ALANGHSE-F-04
REV. 01
Controlled Form
SECTION 1: REQUISITION PERMIT IDENTIFICATION
Applicant (Mukadam)VISHAL PANDEY Ship NameVISHAL PANDEY
Location / Work Description[ CW_LOCATION ] - [ CW_DESC ]
Workers / AttendantVISHAL PANDEY / [ CW_ATTENDANT ]
Date / Issue Time2026-08-10 / 08:00 AM Valid Up to / Permit No.08:00 AM / [ CW_PERMIT_NO ] A/B
JHA Report No.[ CW_JHA ] Safe Entry Permit No. (Ext)[ EXT_PERMIT_NO ]
SECTION 2: ASSOCIATED PERMITS SECTION 3: ACTIVITY
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Confined space permit
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Safe for Entry (Vessel)
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Work at height permit
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Other: ☑
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Escape route prep
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Machinery parts removal
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Tank Cleaning
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Cable removal
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Nut & Bolts removal
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Drilling activity
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Misc. Items removal
Liquid Oxygen Loading
SECTION 4: WORK SITE PREPARATION / PRECAUTION
WORK AREA & ENVIRONMENT EQUIPMENT & INFRASTRUCTURE PEOPLE, PPE & AUTHORIZATION CONTROLS
Yes
Gas Monitoring Required?
Yes
Is there confined space areas?
Yes
Is ventilation to the area adequate?
Yes
Are lighting & access adequate?
Yes
Emergency escape route marked?
Yes
No hot work allowed in nearby area?
Yes
Firefighting equipment available?
Yes
Oil Spill kit available before opening pipeline?
Yes
Trolley available for material handling?
Yes
Availability of Healthy tools?
Yes
Inspection of chain block/rope?
Yes
Inspection of safety harness?
Yes
Pre-job Meeting done?
Yes
Permit for CS entry received from competent person?
Yes
Trained worker?
Yes
Are the workers in proper PPE?
Yes
Barricade and proper signage displayed?
SECTION 5: PPE SECTION 6: EMERGENCY ITEMS
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Safety Helmet
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Multi-gas meter
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Cotton/Latex gloves
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S.C.B.A set
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E.E.B.D
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First Aid Box
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Ear plug
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Oil Spill kit
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Safety Shoes
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Safety Harness
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Wet Gel Blanket
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Fire Hose Standby
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Safety Goggles
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Cryo gloves
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Filter mask
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Fire Extinguisher
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Fire pump ready
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Ladder
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Coveralls
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Disposal suit
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Cut resist gloves
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Sand bucket
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Stretcher
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Fire Blanket
SECTION 7: AUTHORISATION CARD
PERMIT APPLICANT
I am satisfied that all precaution has been taken and all safety arrangements will be maintained for entire duration of work.
Name: VISHAL PANDEY
Designation: Ship / Yard Supervisor
Signature:
APPROVAL BY HSE DEPARTMENT
I am satisfied with safety precautions and hereby give permission to commence work.
Name: VISHAL PANDEY
Designation: Safety Officer / HSE Manager
Signature:
PERMIT CONTROLLER / PM-GM
Approval by Plot Manager (PM) / General Manager (GM).
Name: VISHAL PANDEY
Designation: PM/GM
Signature:
SECTION 8: MANDATORY WORK RULES
GENERAL COLD WORK:
1. If "DO NOT ENTER" is displayed, never enter without permit.
2. Never try to suppress a near miss; report it to HSE Manager.
3. Before opening pipelines/machinery, verify tools and status.
4. For any confined space work, CS entry permit is mandatory.
5. Hot work is strictly prohibited on pipelines under this permit.
6. Do not work at any location other than the approved permit area. 		LIQUID OXYGEN (LOX) SPECIFIC:
7. Maintain exclusion zone; declare NO SMOKING / NO HOT WORK.
8. Do not use oil/grease on LOX connections.
9. Monitor tank pressure (PG-1); do not exceed 15 kg/cm².
10. Use only one filling valve at a time. If both open, STOP filling.
11. If safety valve operates, keep away, STOP and inform HSE.
12. Keep PV 6 / PV 7 accessible for emergency isolation.
Mukadam / Maintenance I/C acknowledgement: I have read, understood and explained these instructions to all workers.
Signature: _____________________     Date: 2026-08-10
SECTION 9: PERMIT RETURN (PLEASE TICK WHERE APPLICABLE)
✓/XSTATUS PERSONNAMESIGNATURETIME
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 Permit is closed, job is completed MukadamVISHAL PANDEY 08:00 AM
Safety OfficerVISHAL PANDEY
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 LOX ONLY: Permit is closed, job is completed Maintenance I/C 08:00 AM
Safety OfficerVISHAL PANDEY
SECTION 10: EMERGENCY CONTACT NUMBERS
SL. NO.DESIGNATIONNAMECONTACT NO.
1 HSE MANAGER ROCKY SINGH 7990404108
2 PLOT MANAGER PRAVIN SHIYAL 79846 07070
THIS PERMIT IS VALID FOR MAXIMUM 08 HOURS ONLY INCLUDING REST HOURS.

FORMAT PREPARED BY: HSE MANAGER APPROVED BY: GENERAL MANAGER