ALANGHSE SERVICES PERMIT

ALANGHSE SERVICES

DE-BUNKERING PERMIT

ALANGHSE-F-05
REV. 01
Controlled Form

SECTION 1: REQUISITION PERMIT IDENTIFICATION
Applicant (Mukadam)	VISHAL PANDEY	Ship Name	VISHAL PANDEY
Location / Work Description	[ DB_LOCATION ] - [ DB_DESC ]
Workers / Sub. Contractor	VISHAL PANDEY / [ DB_SUB_CONTRACTOR ] ([ DB_SUB_CONTACT ])
Date / Issue Time	2026-08-10 / 08:00 AM	Valid Up to / Permit No.	08:00 AM / [ DB_PERMIT_NO ] A/B

SECTION 2: ASSOCIATED PERMITS
Confined space permit	Safe for Entry (Vessel)	Work at height permit	Other: [ DB_AP_OTHER ]

SECTION 3: WORK SITE PREPARATION / PRECAUTION

WORK AREA & ENVIRONMENT

EQUIPMENT & INFRASTRUCTURE

PEOPLE, PPE & AUTHORIZATION CONTROLS

Yes

Is the vessel securely moored?

Yes

Is oil boom wrap around hose intact?

Yes

Gas Monitoring Required?

Yes

Is ventilation to the area adequate?

Yes

Are lighting & access route adequate?

Yes

Housekeeping maintained & flammables removed?

Yes

No hot work allowed in nearby area?

Yes

Emergency Assembly Point identified?

Yes

Oil loading area barricaded & stoppers provided?

Yes

Oil tray placed below pump with oil boom?

Yes

First Aid Kit and Oil Spill kit available?

Yes

Oil removal pump kept in confined space?

Yes

Fire equipment available with fire team?

Yes

Portable fire extinguisher at pumping station?

Yes

Inspection of all equipment's/pumps done?

Yes

Electric cables properly insulated?

Yes

Inspection of pipelines/joints/leaks done?

Yes

Drip trays provided under joints?

Yes

Tank connection secured and sealed?

Yes

Availability of equipment in good condition?

Yes

Permit received from competent authority?

Yes

Job Hazard Assessment done?

Yes

Method/clarity of communication established?

Yes

Continuous supervision at inlet/outlet points?

Yes

Procedure for emergency shutdown in place?

Yes

Is the oil removal team trained?

Yes

Are the workers in proper PPE?

Yes

Proper signage for warning displayed?

Yes

Pre-job Meeting done?

Yes

Induction training provided to truck drivers?

SECTION 4: PPE		SECTION 5: EMERGENCY ITEMS
☑ Safety Helmet	☑ Dust mask	☑ S.C.B.A set	☑ E.E.B.D	☑ Stretcher
☑ Coveralls	☑ Cotton gloves	☑ Fire suit	☑ Fire Blanket	☑ First Aid Box
☑ Harness (truck)	☑ Latex gloves	☑ Fire Extinguisher	☑ Fire Hose	☑ Sand bucket
☑ Filter mask	☑ Safety Goggles	☑ Wet Gel Blanket	☑ Safety Harness	☑ Mech. Blowers
☑ Ear plug	☑ Disposal suit	☑ Ladder	☑ Rope

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 7: MANDATORY WORK RULES

1. अगर कहीं भी DO NOT ENTER लिखा हुआ हो तो कभी भी अन्दर न जाये और नाही किसी को जाने दे जब तक आपके पास परमिट न हो|
2. नियर मिस कभी भी छुपाने की कोसिस न करे उसे फौरन सेफ्टी ऑफिसर को रिपोर्ट करे |
3. पाइपलाइन/मसिनेरी पार्ट्स खोलने से पहले अपने टूल्स और अन्य वास्तु (जिससे आप काम में लेते है)उसे चेक करना जरुरी है |
4. अगर आपको डी बंकरिंग परमिट मिल गया है और कहीं बंद जगहे में काम करना हो तो बंदस्थान की अलग से अनुमतिलेना आनिवार्य है|
5. किसी भी टैंक की सफाई करने से पहले करने से पहले बंदस्थान की अनुमतिपरमिट लेना आनिवार्य है |

Mukadam acknowledgement: I have read, understood and explained these instructions to all workers.
Signature: _____________________ Date: 2026-08-10

SECTION 8: PERMIT RETURN (PLEASE TICK WHERE APPLICABLE)
✓/X	STATUS	PERSON	NAME	SIGNATURE	TIME
☑	Permit is closed, job is completed	Mukadam	VISHAL PANDEY		08:00 AM
☑	Permit is closed, job is completed	Safety Officer	VISHAL PANDEY		08:00 AM

SECTION 10: EMERGENCY CONTACT NUMBERS
SL. NO.	DESIGNATION	NAME	CONTACT NO.
1	HSE MANAGER	ROCKY SINGH	7990404108
2	PLOT MANAGER	PRAVIN SHIYAL	79846 07070