Permit to Work Application
v3.2
Purpose. Permit holders complete this form to request a permit for any work that breaks into, isolates, purges, commissions or decommissions a live gas asset.
1.When to use this form
Use this form for every task covered by the Permit to Work and Isolation Policy. Submit it to the permit issuer before the shift on which the work is planned, or immediately for emergency work. The issuer will review the isolation plan and gas monitoring requirements before authorising.
2.Describing the work
Describe the task, the asset and the exact location. Attach the network drawing marked with the isolation points. State the pressure tier and the pipe material so that the issuer can confirm the correct tooling and squeeze-off limits.
3.Isolation plan
List each isolation point with its asset identifier. State the number of customers affected and confirm that the control centre has been notified. Where more than 50 customers are affected the manager approval must be recorded before the permit is issued.
4.Hazard controls
Confirm the controls in place: continuous gas monitoring, fire extinguishers, exclusion zone, traffic management, excavation support and rescue arrangements for any confined space. The issuer must not authorise a permit with a missing control.
5.Authorisation and close out
The issuer and holder both sign the permit. The permit is valid for one shift unless extended by the issuer. On completion the holder records restoration and closes the permit in the Permit to Work Register.