ALANGHSE SERVICES
REV. 01
Controlled Form
ALANGHSE SERVICES |
COLD WORK PERMIT | ALANGHSE-F-04 REV. 01 Controlled Form |
| STEP 1: REQUISITION PERMIT IDENTIFICATION | |||
| Applicant (Mukadam) | VISHAL PANDEY | Ship Name | VISHAL PANDEY |
| Location / Work Description | [ CW_LOCATION ] - [ CW_DESC ] | ||
| Workers / Attendant | VISHAL PANDEY / [ CW_ATTENDANT ] | ||
| Date / Issue Time | 2026-08-10 / 08:00 AM | Valid Up to / Permit No. | 08:00 AM / [ CW_PERMIT_NO ] A/B |
| STEP 2: ASSOCIATED PERMITS / ACTIVITY | |
| ASSOCIATED PERMITS | ACTIVITY |
|
☑ Confined space permit☑ Safe for Entry (Vessel)☑ Work at height permit☑ Other: ☑ |
☑ Escape route prep☑ Machinery parts removal☑ Tank Cleaning Liquid Oxygen Loading
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| STEP 3: PRE-WORK SAFETY VERIFICATION | |||||||
| CRITERIA | Y | N | N/A | CRITERIA | Y | N | N/A |
| 1. Pre-job Meeting done? | ☑ |
10. Trained worker? | ☑ |
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| 2. Gas Monitoring Required? | ☑ |
11. Are the workers in proper PPE? | ☑ |
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| 3. Is there confined space areas? | ☑ |
12. Availability of trolley for material handling? | ☑ |
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| 4. Is ventilation to the area adequate? | ☑ |
13. Availability of Healthy tools? | ☑ |
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| 5. Are lighting & access adequate? | ☑ |
14. Barricade and proper signage displayed? | ☑ |
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| 6. Emergency escape route marked? | ☑ |
15. No hot work allowed in nearby area? | ☑ |
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| 7. Firefighting equipment available? | ☑ |
16. Inspection of chain block/rope? | ☑ |
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| 8. Oil Spill kit available before opening pipeline? | ☑ |
17. Inspection of safety harness? | ☑ |
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| 9. Permit for CS entry received from competent person? | ☑ |
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| STEP 4: PPE / EMERGENCY READINESS | |||
☑ S.C.B.A set |
☑ E.E.B.D |
☑ First Aid Box |
☑ Safety Helmet |
☑ Multi-gas meter |
☑ Cotton/Latex gloves |
☑ Ear plug |
☑ Safety Harness |
☑ Wet Gel Blanket |
☑ Fire Hose Standby |
☑ Oil Spill kit |
☑ Safety Shoes |
☑ Fire Extinguisher |
☑ Fire pump ready |
☑ Ladder |
☑ Safety Goggles |
| STEP 5: JOINT INSPECTION / AUTHORISATION | ||
|
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: |
| STEP 6: SPECIAL INSTRUCTIONS / MUKADAM ACKNOWLEDGEMENT | |
|
GENERAL COLD WORK: 1. Never try to suppress a near miss; report it to HSE Manager. 2. Before opening pipelines/machinery, verify tools and status. 3. Hot work is strictly prohibited on pipelines under this permit. LIQUID OXYGEN (LOX) SPECIFIC: 4. Maintain exclusion zone; declare NO SMOKING / NO HOT WORK. 5. Monitor tank pressure (PG-1); do not exceed 15 kg/cm². 6. 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 |
| STEP 7: PERMIT RETURN | |||||
| ✓/X | STATUS | PERSON | NAME | SIGNATURE | TIME |
☑ |
Permit is closed, job is completed | Mukadam | VISHAL PANDEY | 08:00 AM | |
| Safety Officer | VISHAL PANDEY | ||||
| SECTION 10: EMERGENCY CONTACT NUMBERS | |||
| SL. NO. | DESIGNATION | NAME | CONTACT NO. |
| 1 | HSE MANAGER | ROCKY SINGH | 7990404108 |
| 2 | PLOT MANAGER | PRAVIN SHIYAL | 79846 07070 |