Permit number : P290-00-5713663

State : Waiting for verification

Lifetime expires on

Hot Work - Medium

Title Demolition of Lorie's Ramp Near Filling Gantry

Description of work: • Mobilization of Material and Man-power to site

• Area Barricade & gas testing
• Demolition of Lories ramp using hilti machine
• Shifting of Debris
• Level the floor & plaster works (Civil Work)
• Housekeeping & De-mobilization

Emergency Information
Muster point Assembly point near security office

Communication Radio/verbal

Other Emergency Information ESD working

Details

Planned Start Date: 08 Jul 2023

Planned End Date: 22 Jul 2023

Site: DS T&S East Machike

Area Authorization DS T&S East Machike

Work locations: P290 - NDP tankfarm Area

Equipment description: Lories Ramp

Hazardous Substance and Hazardous Area N/A

classification
Work order number:

Work Performer: Naseem and Son

Vehicles, Equipment and Tools to be used Hilti Machine, Wheel Barrow, Fire Extinguisher, Spade, Cement and other general hand & Civil tools

Expected Number of People 6

ICC Requirement None

Is Start Work Check required? No

Selected Start Work Check(s) Hot Work
Lead Discipline: Maintenance

Initial Gas test by Authorised Person: Yes

Continuous gas monitoring required? Yes

Influence of nearby activities:

Hazardous Area Classification Zone 2

General comments

Any information entered should not affect the Ensure Proper PPEs suitable with the task
assigned risk level, identified hazard/controls or No Drilling work during operation.
permit type:

Initial signatures
Type Name: Date: Dep./Company:

Request by Permit Requester Abdul Samad 08 Jul 2023 19:25 Naseem & Sons
P290-00-5713663 08/07/2023 19:26 Page 1 of 13
Signature History
Type Name: Date: Dep./Company: Remarks:

Request by Permit Requester Abdul Samad 08 Jul 2023 19:25 Naseem & Sons

P290-00-5713663 08/07/2023 19:26 Page 2 of 13

 Hot Work Workpermit
P290-00-5713663

Substances to be measured Carbon Monoxide [CO <35ppm]

Hydrocarbon [LEL <1perc]

Hydrogen Sulphide [H2S <10ppm]

Oxygen [O2 20perc - 21.5perc]

Note - The printed measurement are the last measurement for each substance, entered into Permit Vision

Date Time Substance Value Signer Remarks

P290-00-5713663 08/07/2023 19:26 Page 3 of 13

 Keep this record with the PTW paper copy, & display these at the worksite

All members of the work party have participated in the LMRA and are Name of holder
familiar with the Jobscope and Hazard&Controls.
Company
Name Initials Name Initials
Permit number P290-00-5713663
......................... ......................... ......................... .........................
Date
......................... ......................... ......................... .........................

......................... ......................... ......................... ......................... What kind of work are you going to do?

......................... ......................... ......................... ......................... • Mobilization of Material and Man-power to site

• Area Barricade & gas testing
......................... ......................... ......................... ......................... • Demolition of Lories ramp using hilti machine
• Shifting of Debris
• Level the floor & plaster works (Civil Work)
• Housekeeping & De-mobilization

Has the Permit Issuer discussed the hazards & Does the work party know the emergency alarm
controls with the Permit Holder? Yes n/a and action required in event of an alarm or Yes n/a
accident?
Has the Permit Holder warned others that may be
affected by your work? Yes n/a Does the work party know the most effective Yes n/a
escape route and the location of the nearest
muster point?
Is there conflicting work that may affect you? Yes n/a Yes n/a
If yes describe hazards and controls below. Does the work party know the location of the
nearest eyewash station, emergency shower, first
aid kit and AED device?

Are there additional hazards that need to be controlled? If newly identified hazards are material changes to the permit, contact Permit Issuer!

Hazards Controls / Recovery Measures

.............................................................................................................. ..............................................................................................................

.............................................................................................................. ..............................................................................................................

.............................................................................................................. ..............................................................................................................

Pictograms for key hazards Indicate which Life Saving Rules are applicable.

Bypassing Safety Confined Space Driving

Controls

Obtain authorization Obtain authorization before Follow safe driving rules

MOTION PEOPLE
before overriding or entering a confined space
disabling safety controls
Energy Isolation Hot Work Line of Fire

Verify isolation and zero Control flammables and Keep yourself and others out
energy before work ignition sources of the line of fire
begins
Safe Mechanical Work Authorisation Working At Height
Lifting

Plan lifting operations and Work with a valid permit Protect yourself against a fall
control the area when required when working at height

P290-00-5713663 08/07/2023 19:26 Page 4 of 13

 Start-Work Checks | Hot Work
Start Work Authority: Confirm below are in place and verified prior to starting work
Save Your Life Actions Person(s) Start-Work
All exposed person(s) performing work must confirm each of the action items Performing Verifier
below Work (initial) (initial)

Energy Isolation
I have confirmed:
1 The Hot Work has been evaluated for Energy Isolation requirements. Does Hot
Work require Energy Isolation? If Yes: Complete Energy Isolation Start-Work
Check. If No: Continue to the next step2.

Hot Work
I have confirmed:
2 The hazards have been identified, controlled and it is safe to start.
3 Is the Hot Work in a Hazardous area? If Yes: Confirm the initial gas test has been
completed. If No: Move to Step 5
4 The Hot Work atmosphere will be continually monitored.
5 Ignition sources are identified and controlled.
6 Flammable/combustible materials have been removed or isolated.
Stop and seek help if any of the above controls/safeguards are not in place

Role Printed Name Date

Start -Work Verifier

P290-00-5713663 08/07/2023 19:26 Page 5 of 13

 Save Your Life Actions | Hot Work
Start Work Authority: I will not start work until I confirm...
Actions How to (examples)
Energy Isolation
1 The Hot Work has been evaluated for Energy Isolation requirements. Does Hot Work • All potential energy sources have been identified, isolated and locked and tagged per isolation plan.
require Energy Isolation? If Yes: Complete Energy Isolation Start-Work Check. If No: • The system has been drained, flushed, or purged to remove flammable/explosive materials or gases.
Continue to the next step2.

Hot Work
2 The hazards have been identified, controlled and it is safe to start. • Complete a task risk assessment specific to the scope of work
• Discuss hazards with the work team prior to the start of work
• Check for simultaneous operations that may introduce an additional hazards
3 Is the Hot Work in a Hazardous area? If Yes: Confirm the initial gas test has been • The initial gas test has been completed by a Qualified Gas Tester.
completed. If No: Move to Step 5 • At all openings below and above the hot work area
• At a minimum distance around the hot work area
• Gas readings are within the required range

Note: Confirm gas testing outside of defined hazardous area if required for other reasons. Gas testing should be in compliance with company requirements and applicable regulations.
4 The Hot Work atmosphere will be continually monitored. • Follow-up test frequency is documented (e.g., permit) before starting work.

Note: 'Continually' monitored means periodic monitoring of the atmosphere with a defined frequency or continuous monitoring throughout the duration of work activities.
5 Ignition sources are identified and controlled. • Barriers are in place to prevent ignition in the hot work area:
•Drains, gaps, openings in tanks or piping have been covered/sealed
•Vents are isolated/routed away from the area
• A trained Fire Watch has been designated and is at the work location.
• Firefighting equipment is inspected, on site and fully functional.
6 Flammable/combustible materials have been removed or isolated. • All flammable/combustible materials have been removed or, if not removed, measures (e.g., fire blankets) are in place to shield them from ignition sources

P290-00-5713663 08/07/2023 19:26 Page 6 of 13

 RA/JHA P290-00-5713664
Attached to: Permit P290-00-5713663

Title: Demolition of Lorie's Ramp Near Filling Gantry

Team: Abdul Samad, Muhammad Ramzan Approval:

Task steps Hazards Control measures Action party

Mobilization of Material • Use of non-recommended, self-fabricated and banned tools / • Only certified, Tested and pre-inspected Equipment to be S Permit Holder
and Man-power to site plant / equipment may lead to personal injury and damage to used.
terminal assets. • Ensure that no safety guard is removed from tools.
• No homemade hand tool is allowed at site.
• Provide red tag and remove any hand tool if it gets damaged
during work at site.
• Access the load before handling to ensure safe grip.
• Wear adequate PPEs and additional PPEs where required.

[.MO.12] Slips & Trips (MOTION) [.MO.12.01] Remove any trip hazards in the area, clean up any S Permit Holder
spills, wear anti-slip safety shoes
[.PE.07] Hazardous Weather (PEOPLE) [.PE.07.02] Set weather limitations (lightning, rain, wind speed) S Permit Holder
and stop work when limit is exceeded.
[.PE.05] Fatigue (PEOPLE) [.PE.05.02] Prior to start of work request work party to self S Permit Holder
report if they are suffering from fatigue
[.PE.05.04] Monitor for signs of fatigue and intervene/stop work S Permit Holder
if necessary.
• Area Barricade & gas Presence of Flammable gases Ensure gas testing S Permit Holder
testing
[.PE.01] Communication (PEOPLE) [.PE.01.01] During permit issuance and toolbox talk/Last Minute S Permit Holder
Risk Assessment discuss and agree the methods of
communication within the work party, with Operations (if
necessary) and with Emergency Responders (if necessary)
[.PE.05] Fatigue (PEOPLE) [.PE.05.02] Prior to start of work request work party to self S Permit Holder
report if they are suffering from fatigue
[.PE.05.04] Monitor for signs of fatigue and intervene/stop work S Permit Holder
if necessary.
[.PE.07] Hazardous Weather (PEOPLE) [.PE.07.02] Set weather limitations (lightning, rain, wind speed) S Permit Holder
and stop work when limit is exceeded.
[.MO.12] Slips & Trips (MOTION) [.MO.12.01] Remove any trip hazards in the area, clean up any S Permit Holder
spills, wear anti-slip safety shoes

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 RA/JHA P290-00-5713664
Attached to: Permit P290-00-5713663

Demolition of Lories Hilti Machine ( Hazards) Ensure Proper PPEs suitable with the task S Permit Holder
ramp using hilti machine
Ensure Area barricade S Permit Holder
Ensure Ear Plugs S Permit Holder
Ensure Hilti is third party certified S Permit Holder
[.PE.05] Fatigue (PEOPLE) [.PE.05.02] Prior to start of work request work party to self S Permit Holder
report if they are suffering from fatigue
[.PE.05.04] Monitor for signs of fatigue and intervene/stop work S Permit Holder
if necessary.
Ensure Proper Rest Breaks S Permit Holder
[.PE.07] Hazardous Weather (PEOPLE) [.PE.07.02] Set weather limitations (lightning, rain, wind speed) S Permit Holder
and stop work when limit is exceeded.
[.PE.01] Communication (PEOPLE) [.PE.01.01] During permit issuance and toolbox talk/Last Minute S Permit Holder
Risk Assessment discuss and agree the methods of
communication within the work party, with Operations (if
necessary) and with Emergency Responders (if necessary)
[.MO.05] Hand Tools - ALL (MOTION) [.MO.05.03] Wear appropriate hand protection suitable for task S Permit Holder
Ensure Proper PPEs when using hilti machine S Permit Holder
Ensure all equipment is third party certified S Permit Holder
Keep all out of line of fire S Permit Holder
Ensure Ear Plugs S Permit Holder
[.MO.12] Slips & Trips (MOTION) [.MO.12.01] Remove any trip hazards in the area, clean up any S Permit Holder
spills, wear anti-slip safety shoes
Shifting of Debris [.MO.12] Slips & Trips (MOTION) [.MO.12.01] Remove any trip hazards in the area, clean up any S Permit Holder
spills, wear anti-slip safety shoes
[.MO.11] Sharp, abrasive objects (MOTION) Use cut resistant gloves S Permit Holder
[.PE.07] Hazardous Weather (PEOPLE) [.PE.07.02] Set weather limitations (lightning, rain, wind speed) S Permit Holder
and stop work when limit is exceeded.
[.PE.05] Fatigue (PEOPLE) [.PE.05.02] Prior to start of work request work party to self S Permit Holder
report if they are suffering from fatigue
[.PE.05.04] Monitor for signs of fatigue and intervene/stop work S Permit Holder
if necessary.
Ensure Proper Rest Breaks S Permit Holder
Level the floor & plaster [.MO.05] Hand Tools - ALL (MOTION) Never use damaged tools and equipment's S Permit Holder
works (Civil Work)
P290-00-5713663 08/07/2023 19:26 Page 8 of 13
 RA/JHA P290-00-5713664
Attached to: Permit P290-00-5713663

[.MO.12] Slips & Trips (MOTION) [.MO.12.01] Remove any trip hazards in the area, clean up any S Permit Holder
spills, wear anti-slip safety shoes
[.PE.05] Fatigue (PEOPLE) [.PE.05.02] Prior to start of work request work party to self S Permit Holder
report if they are suffering from fatigue
[.PE.05.04] Monitor for signs of fatigue and intervene/stop work S Permit Holder
if necessary.
Ensure Proper Rest Breaks S Permit Holder
[.PE.01] Communication (PEOPLE) [.PE.01.01] During permit issuance and toolbox talk/Last Minute S Permit Holder
Risk Assessment discuss and agree the methods of
communication within the work party, with Operations (if
necessary) and with Emergency Responders (if necessary)
Housekeeping & De- [.MO.12] Slips & Trips (MOTION) [.MO.12.01] Remove any trip hazards in the area, clean up any S Permit Holder
mobilization spills, wear anti-slip safety shoes
[.MO.05] Hand Tools - ALL (MOTION) [.MO.05.03] Wear appropriate hand protection suitable for task S Permit Holder
[.PE.05] Fatigue (PEOPLE) [.PE.05.02] Prior to start of work request work party to self S Permit Holder
report if they are suffering from fatigue
[.PE.05.04] Monitor for signs of fatigue and intervene/stop work S Permit Holder
if necessary.
[.PE.07] Hazardous Weather (PEOPLE) [.PE.07.02] Set weather limitations (lightning, rain, wind speed) S Permit Holder
and stop work when limit is exceeded.
[.PE.01] Communication (PEOPLE) [.PE.01.01] During permit issuance and toolbox talk/Last Minute S Permit Holder
Risk Assessment discuss and agree the methods of
communication within the work party, with Operations (if
necessary) and with Emergency Responders (if necessary)

P290-00-5713663 08/07/2023 19:26 Page 9 of 13

 Corresponding Permit to Work No:

F Method Statement P290-00-5542272

The Permit Issuer, when developing the respective Permit forms, will use the Method Statement supplied.

Company: Naseem & Son Project: Demolition of Lorie's Ramp Near Date: 27/05/2023
Filling Gantry

1. Description of works
What the work entails?
Demolition of Lorie's Ramp Near Filling Gantry
How is it going to be completed? Summarise the operation

1) Mobilization of material and manpower to site

2) Area Barricade & gas testing
3) Demolition of Lories ramp using hilti machine
4) Shifting of Debris
5) Level the floor & plaster works (Civil Work
6) Housekeeping & De-mobilization

Where is the work going to be completed? (Summary – more details on section 5)

See detail in section 5
Duration of the work? (Stating any times when access to the Terminal will not be required.)
30 days
Include site location drawings if appropriate?
No
Are there any restrictions e.g. overhead power lines?
Nil
Are local permits required (Local regulations)?
Yes
Any other details
Nil

2. Names of Responsible persons

Who is going to be working on the project?
Abdul Samad
Who will be in charge?
Abdul Samad
Who has specific responsibilities? e.g. Plant, personnel, materials, etc.
Abdul Samad
Who is to make contact with local authorities?
Abdul Samad
Any other details

3. Plant and Equipment

What plant equipment and tools are required to do the job?
Hilti Machine, Wheel Barrow and other general hand or civil tools
 Tools (that may generate sparks, ignitions sources, etc.)
Nil
 Cherry pickers
Nil
 Scaffolding
Nil
 Loading of materials
Nil
 Others, specify
Nil

Form F – Method of Statement Distribution Permit to Work

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Procedure System
What certificates, if any, are required for plant or equipment?
Hilti Machine
What training, if any, is required for operatives?
Safety Orientation

4. Communications with the workforce

How are the procedures, hazards to be communicated to the workforce ?

 After getting desired work permits, a group communication meeting shall be conducted to
convey the action plan in case of any change in condition, like bad weather (rain/ storm etc) or
any change in plant/process area in the form of fire, leak of gas/oil/water etc. and also in case
of fire alarm/hooter

 In case of any emergency and where alarm goes on, all personnel must be evacuated
immediately from the work place and must be report to muster point. Extreme care should be
considered to avoid any unlikely injury caused by panic

 In case the accident, SHELL terminal ERP will be activate to arrange the ambulance

 In case of any injury occurred then rescue team shell be called up at the scene with all safety
precautions and take out the injured person using the stretcher and shift him at safe place to
provide him first aid or in case of severe injury the team should rush to nearest
hospital/medical centre
 The incident shall be reported verbely to permit issuer and later incident report shall be
prepared and submit to client accordingly

Toolbox talks, safety meetings etc.

Toolbox meeting at the start of work regarding safe work.
Include records of any such meetings and record attendance.
Yes, toolbox form shall be filled on daily basis.
Other, specify.
PROPER HOUSEKEEPINH

5. How will the work be completed, i.e. Procedure step by step

Proposed Start date
23/09/2022
Step 1 : Mobilization of Tools, Equipment and Manpower to Site.
 Equipment and tool will be mobilized at site according to
requirement.
 Visual inspection of tools and equipment.
 Trained and competent resources must be deployed.
Step 2: Area Barricade & gas testing
 Ensure Area Barricade to prevent unauthorized entry in working area
 Ensure Gas testing before starting work
 Ensure Proper PPEs Suitable with the task
Step 3: Demolition of Lories ramp using hilti machine
 Ensure Area barricade & gas testing before starting work
 Ensure Hilti machine is third party certified
 Ensure Proper PPEs like goggles with side sheet
 Ensure Ear Plugs
 Ensure Housekeeping
 Never use damaged tools and equipment
 Ensure Inspection before each use

Form F – Method of Statement Distribution Permit to Work

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Procedure System
 Step 4: Shifting of Debris
 Sift Debries to designated place by SPL team
 Ensure Proper Housekeeping on Daily basis
 Ensure PPEs

Step 5: Level the floor & plaster works (Civil Work)

 After Demoliton if required level the floor and plaster to repair
cracks by cement
 Ensure Housekeeping

Step 6: De-Mobilization of Equipment and Manpower.

After job completion tools,equipment,waste material and man power wil be de-mobilize .

Step 7: Housekeeping.
Housekeeping of the working area will be done during and after job.

Form F – Method of Statement Distribution Permit to Work

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Procedure System
P290-00-5713663 08/07/2023 19:26 Page 13 of 13