HEALTH AND SAFETY MANUAL

DHI-EHS-HSM-031

PERMIT TO WORK

Copyright This document is the property of Doosan Heavy Industries and Construction and all rights are
reserved in respect of it. This document may not be reproduced or disclosed in any manner what so ever, in
whole or in part, without the prior written consent of Doosan.

Doosan expressly disclaims any responsibility for or liability arising from the use
of this document by any third party. Copies printed are UNCONTROLLED.

Revision Details Next Review: January 2015

Rev. Date Revision Status Checked Approved

00 31/03/2014 Draft Yonghyun Kim Seungmin Park

DHI-EHS-HSM-031 (March 2014), Page 1 of 21

PURPOSE AND SCOPE

This manual describes system of control potentially high risk operations through the issue of a Permit to Work
(PTW).

DEFINITIONS

Permit to Work (PTW): Is a system which ensures that all essential precautions have been taken
and where necessary, physical safe guards are in place to allow particular
high risk work to proceed.
PROCEDURE

Operations that involve, but are not limited to the use of toxic materials or explosive devices, confined space
entry, on or near live electrical equipment or other similar hazardous work shall require a Permit to Work to be
used.

Safe working depends on trained people strictly applying and adhering to all appropriate company and legislative
procedures.

Permit to Work systems and procedures constitute the most formal method of ensuring safe working practices.
The responsible Permit Holder shall ensure that the safe work practices outlined on the permit and all other
requirements of the Work Permit are strictly adhered to during the task being performed.

The EHS department is responsible for keeping a copy of Permit to Work issued.

Hazardous work to be carried out under the Permit to Work must have risk assessment conducted prior to issue
of Work Permit. The necessary control measures must also be indicated in the Work Permit. The Work Permit
should also be displayed at the Work Area.

1.0 Hazard Identification and Risk Assessment

Identification of Hazards in Relation to Work Permits will depend upon the purpose of the Permit e.g.
 Hot Works
 Excavation
 Lifting more than 10t, twin lifts or complicated lifts
 Night Work/ Holiday Work
 Confined Spaces
 Ionizing Radiation Work
 Working over Water
 Diving

A specific Risk Assessment Form and Job Safety Analysis Form must be attached to the Permit.

DHI-EHS-HSM-031 (March 2014), Page 2 of 21

2.0 Risk Checklist
 Carry out preliminary survey of work and work area to ascertain dangers.
 Analyze the work and level of exposure to hazards.
 Appoint competent personnel to execute the work.
 Carry out any specific training prior to commencement.
 Ensure all necessary PPE is provided.
 Ensure necessary Emergency back-up/support measures are in place prior to commencement.
 Ensure others who are in the vicinity of the work are notified and protected against the hazards.
 Ensure a copy of the Permit is posted at the work area and times strictly complied with.

DHI-EHS-HSM-031 (March 2014), Page 3 of 21

Attachment 1
HOT WORK PERMIT
Project Name Date:

PERMIT REQUIRED FOR WELDING GAS CUTTING BRAZING GRINDING Others

Location:

Section – I DETAILS OF THE PERMIT RECIVER (SC = Sub Contractor, DHI = DOOSAN)
Permit Receiver (SC) Contact Number
Engineer Responsible (DHI) Contact Number
Name of the Welder (or worker) Gate Pass ID number
Safety In charge (DHI) Contact Number
Section – II PERMIT VALIDATIONS
Date issued Valid Till (Not more than a week)
Time Issued Valid Till (Expires after 0001 hrs)
Extended Date Valid Till (Not more than a week)
Extended Time Valid Till (Expires after 0001 hrs)
Permit Contents: 1) Permit to Hot Work (Two copies one for site one for EHS file)
2) Method Statement and JSEA (Copy for Site)
3) Personnel Training Record Sheet (To be placed in EHS file)

HOT work permit shall not exceed its duration for more than seven (7) days.
Work Permit shall be renewed on the Eighth (8th) day WITHOUT FAIL

Section – III PREREQUISITE (Work May be stopped if one of the following is not complied with)
Yes/ Yes/
 for YES and X for No NA  for YES and X for No NA
No No
A Flammable Materials removed from location K Appropriate Working Platform
B Welding Gensets terminal insulation L Safety/Warning Signs in place
C Adequate Earthing M Adequate Ventilation
D Area of work clean and dry N Condition of the welding cables
E Appropriate Fire Extinguisher Provided O Adequate illumination
F Operatives trained in using fire extinguisher P Flash Back arrestors - Gas Cylinders
G Fire Blankets (non flammable) Provided Q Cylinders Kept in trolley and secured
H Fire Watch Personal R Regulators in good condition
I Area barricaded S Gas test required
J Appropriate PPE Provided T Isolation of Equipments required
Declaration by the Permit Receiver Name and address of Permit Receiver

I_________________ representing _________________ hereby declare that I Company Name: ………………………………………………………

have checked the location and the welder has been briefed about the emergency Nature of Job: ………………………………………………. ………
procedure and a toolbox talk given on using the fire extinguisher to ALL involved
Tel.No…………………………………………………………………
in the activity.
Email…………………………………………………………………
Date: ……/……/…… Name; ……………. Signature;

Contact Number (Site Safety Rep)………………………..

DHI-EHS-HSM-031 (March 2014), Page 4 of 21

Section IV PERMIT APPROVAL

Reviewed by Doosan Manager: ………………………………………………………… Signature …………………………… Date …….../…..…./……..

Comments.

Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. On / / . It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected from
the main source of power supply.

Name of the Doosan EHS Manager:………………………………..…………………….. Signature …………………………… Date …….../…..…./……..

Comments

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Doosan Civil/ Doosan Electrical/ Doosan QA/ QC
Project Director ( )
Architecture Manager Mechanical Manager Manager
Subcontractor Subcontractor Area
( ) ( ) Security
Site Manager Manger

DHI-EHS-HSM-031 (March 2014), Page 5 of 21

Attachment 2
PERMIT TO EXCAVATE
Project Name Date:

PERMIT REQUIRED FOR Excavation LOCATION:

Section – I DETAILS OF THE PERMIT RECEIVER (SC = Sub Contractor, DHI = DOOSAN)
Task Supervisor/Foreman(SC) Contact Number
Engineer Responsible (DHI) Contact Number
Safety Advisor on Site (DHI) Contact Number
Section – II (Eng. Responsible) PERMIT VALIDATIONS
PERMIT ISSUE DETAILS Date ____________________ Time ________________ NO EXTENSION WILL BE GIVEN

PERMIT EXPIRY DETAILS Date ____________________ Time ________________ ON THIS PERMIT

Permit Contents: 1) Permit to Excavate (Two copies one for site one for EHS file)
2) Method Statement and JSEA (Copy for Site)
3) Personnel Training Record Sheet (To be placed in EHS file)

ALL EXCAVATIONS IN EXCESS OF 1.2M DEEP SHOULD BE APPROVED THIS PERMIT.

THIS PERMIT IS ONLY TO BE USED BY THE PERSONS TO WHOM IT IS ISSUED. ON COMPLETION OF THE TASK OR ON EXPIRY THE
PERMIT IS TO BE RETURNED TO THE ISSUER FOR CANCELATION

Section – III (By SubContractor) PREREQUISITE (Work May not commence if one of the following is not complied with)
 for YES and X for No Yes/No NA  for YES and X for No Yes/No NA
Is the Work Area Clearly Defined? Have the Latest DOC Services indicated by walk through with
A
drawings been Consulted? H operatives designated to the task and safe
B Has the Area been Checked Underground Utilities? exclusion zones been indicated by barriers.
Water / Sewer / Irrigation / Drainage
C Are All Service Locations Clearly Marked? I
( 1m Exclusion)
D Have All necessary Trial Trenches been Excavated? Electrical 11 Kv or Higher Voltage
J
(3m Exclusion)
Has a Risk Assessment been Completed for the Task of
E
Excavating Near the Services? K Electrical Lower than 11 Kv (1m Exclusion)

Have The Operatives for the task been briefed on the Risk L Telecommunication (1m Exclusion)
F
Assessment. Is this Signed for? M Oil/Gas (10m Exclusion)
Are the Required Controls in Place as per the Risk N Overhead Services (Contact Service owner)
G Assessment?
O Other (including Structures)
Attended Briefing 1 5
2 6
Details of Employees working 3 7
in the Excavation 4 8
Name, Company
Planned Equipment For
Declaration by the Permit Receiver (SC) Allowed / Disallowed
Excavation

I_________________ representing _________________ hereby declare that I have

checked the location and all the employees have been briefed about the emergency
procedure and services associated with this area of excavation.

Date: ……/……/…… Name; ……………. Signature; …………….. PTW CANCELLED: By:

DHI-EHS-HSM-031 (March 2014), Page 6 of 21

Section IV PERMIT APPROVAL

Reviewed by Doosan Manager: ………………………………………………………… Signature …………………………… Date …….../…..…./……..

Comments.

Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. On / / . It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected from
the main source of power supply.

Name of the Doosan EHS Manager:………………………………..…………………….. Signature …………………………… Date …….../…..…./……..

Comments

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Doosan Civil/ Doosan Electrical/ Doosan QA/ QC
Project Director ( )
Architecture Manager Mechanical Manager Manager
Subcontractor Subcontractor Area
( ) ( ) Security
Site Manager Manger

DHI-EHS-HSM-031 (March 2014), Page 7 of 21

Attachment 3
CRANE OPERATING PERMIT
Project Name Date:

PERMIT REQUIRED FOR Crane Operation LOCATION:

Section – I DETAILS OF THE PERMIT RECEIVER (SC = Sub Contractor, DHI = DOOSAN)
Task Supervisor/Foreman(SC) Contact Number
Engineer Responsible (DHI) Contact Number
Safety Advisor on Site (DHI) Contact Number
Section – II PERMIT VALIDATIONS
Date issued Valid Till (Not more than a week)
Time Issued Valid Till (Expires after 0001 hrs)
Extended Date Valid Till (Not more than a week)
Extended Time Valid Till (Expires after 0001 hrs)
Section – III PREREQUISITE (Work May be stopped if one of the following is not complied with)
 for YES and X for No Yes/No NA  for YES and X for No Yes/No NA
A Lifting procedure/prepared/planned? K Main brake system functioning?
B Crane inspected/Jibs good condition? L Safety/Warning Signs in place?
C Work area in safe-condition? M Winch brake system functioning?
D Lifting calculation completed/Load Test/Charts? N Ground stability checked?
E Height clearance completed? O Stability of crane outriggers?
Dedicated signalman (one person only) with
F Shackles inspected? P
vest?
G Slings inspected with certificates? Q Weather in good condition?
Area supervisor/safety personnel
H Spreader bar inspected? R
supervision?
I Reverse alarm & lights functioning? S Fire extinguisher in place?
J Doors & windscreen good condition? T Steel plates (where required)?
Crane : Type : Model No. : Vehicle No.:
Year of Manufacturing Crane :
Operator Name: Operator Certificate No.:

Maximum Weight of the Load:

Declaration by the Permit Receiver Name and address of Permit Receiver

I_________________ representing _________________ hereby declare that I Company Name: ………………………………………………………

have checked the location and the welder has been briefed about the Nature of Job: ………………………………………………. ………
emergency procedure and a toolbox talk given on using the fire extinguisher to
Tel.No…………………………………………………………………
ALL involved in the activity.
Email…………………………………………………………………
Date: ……/……/…… Name; ……………. Signature;

Contact Number (Site Safety Rep)………………………..

DHI-EHS-HSM-031 (March 2014), Page 8 of 21

Section IV PERMIT APPROVAL

Reviewed by Doosan Manager: ………………………………………………………… Signature …………………………… Date …….../…..…./……..

Comments.

Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. On / / . It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected
from the main source of power supply.

Name of the Doosan EHS Manager:………………………………..…………………….. Signature …………………………… Date …….../…..…./……..

Comments

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Doosan Civil/
Project Doosan Electrical/ Doosan QA/ QC
Architecture ( )
Director Mechanical Manager Manager
Manager
Subcontractor Subcontractor Area
( ) ( ) Security
Site Manager Manger

DHI-EHS-HSM-031 (March 2014), Page 9 of 21

Attachment 4
ELECTRICAL WORK PERMIT

Project Name Date:

Description of
Work

PERMIT REQUIRED FOR Electrical Work LOCATION:

Section – I PERMIT RECIVER DETAILS

Permit Receiver (SC) Contact Number
Engineer Responsible (DHI) Contact Number
Safety In charge (SC) Contact Number
Safety Advisor on Site (DHI) Contact Number
Section – II PERMIT VALIDATIONS
Date issued Valid Till
Time Issued Valid Till
Extended Date Valid Till
Extended Time Valid Till
Section – III PREREQUISITE (Work will be stopped if one of the following is not complied with)
Details of the 220 volt power tool  for YES and X for No Yes NA
ELCB Tested and
1 Type of Power Tool A
Drill Breaker Others certified
2 Reason for using the equipment ; Industrial Sockets
B
……………………………………………………………………………………………………………………………………………………………………………………………………………… (Blue) in use
C Armoured cable
Toolbox talk on use of
D
220 volt elec.
Equipment is
3 Manufacture E
adequately earthed
Serial Safety Warning Signs
4 F
Number in place
5 Electricians Declaration Dead Mans Switch
G
I_________________ representing _________________ hereby declare that I have checked the functioning
location/machine mentioned above and confirm that it is in line with all safety requirements and is Double Insulated
safe to be used. H
casings
I Area of work kept dry
J Cables appropriately
Date :……/……/…… Name; ……………. Signature ;…………….. protected
Section IV PERMIT APPROVAL

Reviewed by Doosan Manager: ………………………………………………………… Signature …………………………… Date ………/…..…./……..

Comments.

Section IV PERMIT APPROVAL

DHI-EHS-HSM-031 (March 2014), Page 10 of 21

Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. On / / . It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected
from the main source of power supply.

Name of the Doosan EHS Manager:………………………………..…………………….. Signature …………………………… Date ………/…..…./

……..

Comments

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Project Doosan Civil/ Doosan Electrical/ Doosan QA/ QC
( )
Director Architecture Manager Mechanical Manager Manager
Subcontractor Subcontractor Area
( ) ( ) Security
Site Manager Manger

DHI-EHS-HSM-031 (March 2014), Page 11 of 21

Attachment 5
NIGHT WORK/ HOLIDAY WORK PERMIT
Project Name Date:

Description of
Work

PERMIT REQUIRED FOR Night Work Holiday Work LOCATION:

Section – I
Task
Supervisor/Foreman(SC)
Engineer Responsible (DHI)
Safety Advisor on Site (DHI)
Section – II (Eng. Responsible)
PERMIT ISSUE DETAILS
DETAILS OF THE PERMIT RECEIVER (SC = Sub Contractor, DHI = DOOSAN)
Contact Number
Contact Number
Contact Number
PERMIT VALIDATIONS
Date ____________________ Time ________________ NO EXTENSION WILL BE GIVEN

PERMIT EXPIRY DETAILS Date ____________________ Time ________________ ON THIS PERMIT

IN CASE OF NIGHT WORK PERMIT, THE PERMIT SHOULD BE SUBMITTED AND DISCUSSED BEFORE 4 PM. ALL REQUIRED SAFETY
WORK PREPARATION BEFORE 5 PM and IT HAS TO BE CONFIRMED WITH Doosan EHS MANAGER.

IN CASE OF HOLIDAY WORK, THE PERMIT SHOULD BE SUBMITTED AND DISCUSSED AT LEAST ONE DAY BEFORE.

Section – III PREREQUISITE (Work May be stopped if one of the following is not complied with)
 for YES and X for No Yes/No NA  for YES and X for No Yes/No NA
A Sufficient illumination provided? D Are additional permit need?
Is security notified of the night
B Are all employees equipped with clear safety glasses? E
work/holiday work?
Are all employees trained emergency
C Is there an ambulance and nurse present? F
responses?
Attended Briefing 1 5
2 6
Details of Employees 3 7
working in the night/ holiday 4 8
Name, Company
Planned Equipment For Night
Declaration by the Permit Receiver (SC) Allowed / Disallowed
Work/ Holiday Work

I_________________ representing _________________ hereby declare that I have

checked the location and all the employees have been briefed about the emergency
procedure and services associated with this area of excavation

Date: ……/……/…… Name; ……………. Signature; …………….. PTW CANCELLED: By:

DHI-EHS-HSM-031 (March 2014), Page 12 of 21

Section IV PERMIT APPROVAL

Reviewed by Doosan Manager: ………………………………………………………… Signature …………………………… Date …….../…..…./……..

Comments.

Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. On / / . It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected
from the main source of power supply.

Name of the Doosan EHS Manager:………………………………..…………………….. Signature …………………………… Date …….../…..…./……..

Comments

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Project Doosan Civil/ Doosan Electrical/ Doosan QA/ QC
( )
Director Architecture Manager Mechanical Manager Manager
Subcontractor Subcontractor Area
( ) ( ) Security
Site Manager Manger

DHI-EHS-HSM-031 (March 2014), Page 13 of 21

Attachment 6
CONFINED SPACE ENTRY PERMIT
Project Name Date:

ENTRY REQUIRED FOR PAINTING FINISHING HOT WORKS Others (Specify) ……………………..

Location(s) :

Section – I DETAILS OF THE PERMIT RECIVER (SC = Sub Contractor, DHI = DOOSAN)
Permit Receiver (SC) Contact Number
Engineer Responsible (DHI) Contact Number
Safety In charge (SC) Contact Number
Safety Advisor on Site (DHI) Contact Number
Section – II PERMIT VALIDATIONS
PERMIT ISSUE DETAILS Date ____________________ Time ________________ NO EXTENSION WILL BE

PERMIT EXPIRY DETAILS Date ____________________ Time ________________ GIVEN ON THIS PERMIT
Permit Contents: 1) Permit to Confined Space Entry (Two copies one for site one for EHS file)
2) Method Statement and JSEA (Copy for Site)
3) Personnel Training Record Sheet (To be placed in EHS file)
This permit covers ENTRY ONLY to a confined space.
All work entailed in effecting entry and after entry shall be covered by the appropriate WORK PERMIT.

Section – III PREREQUISITE (Work May be stopped if one of the following is not complied with)
Yes/ Yes/
 for YES and X for No NA  for YES and X for No NA
No No
A Atmosphere in the Confined Space Tested? K If so, are the equipments isolated?
B Oxygen level is 19.5% (Should not be less/more) L Is the main source of supply tagged?
C Will the atmosphere be monitored during work? M Has the toolbox talk been given?
D Continuously/Periodically Specify Interval N Air intake system located free from fume?
E Has the space been ventilated before entry? O Preparedness for emergency response?
F Will ventilation be continued during work? (LEV) P Work Method Statements submitted?
G Was the space found unacceptable? Q Will any Chemicals be used in the space?
H If so, after ventilation was the area retested? R Adequate illumination to carry out the job?
I Are there any other equipment running? S Appropriate PPE Provided?
J Will any other equipment be used in the space? T Watcher(s) required?
1 5
Details of Employee working 2 6
in the confined space
Name, Company 3 7
4 8
Details of Equipment and/or
Material being used

Section IV PERMIT APPROVAL

Reviewed by Doosan Manager: ………………………………………………………… Signature …………………………… Date ………/…..…./……..

Comments.

Section IV PERMIT APPROVAL

DHI-EHS-HSM-031 (March 2014), Page 14 of 21

Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. On / / . It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected
from the main source of power supply.

Name of the Doosan EHS Manager:………………………………..…………………….. Signature …………………………… Date ………/…..…./

……..

Comments

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Project Doosan Civil/ Doosan Electrical/ Doosan QA/ QC
( )
Director Architecture Manager Mechanical Manager Manager
Subcontractor Subcontractor Area
( ) ( ) Security
Site Manager Manger

DHI-EHS-HSM-031 (March 2014), Page 15 of 21

Attachment 7
IONIZING RADIATION WORK PERMIT
Project Name Date:

Location(s)

Section – I
Permit Receiver (SC)
Engineer Responsible (DHI)
Safety In charge (SC)
Safety Advisor on Site (DHI)
Section – II
PERMIT ISSUE DETAILS
DETAILS OF THE PERMIT RECIVER (SC = Sub Contractor, DHI = DOOSAN)
Contact Number
Contact Number
Contact Number
Contact Number
PERMIT VALIDATIONS
Date ____________________ Time ________________ NO EXTENSION WILL BE

PERMIT EXPIRY DETAILS Date ____________________ Time ________________ GIVEN ON THIS PERMIT
Permit Contents: 1) Permit to Ionizing Radiation Work Permit (Two copies one for site one for EHS file)
2) Method Statement and JSEA (Copy for Site)
3) Personnel Training Record Sheet (To be placed in EHS file)
Section – III PREREQUISITE (Work May be stopped if one of the following is not complied with)
Yes/ Yes/
 for YES and X for No NA  for YES and X for No NA
No No
A Radiation areas barricaded? E Rad. meters checked & calibrated?
B Caution notice posted? F Remote handling equip. checked?
C Radiation area boundaries monitored? G Sealed source container checked?
D Warning lights etc. positioned? K Other Necessary Precautions?
Detail of Radiation Source

(a) X-ray apparatus (manufacturing year / type ) :

(b) Max tube voltage: (kv)

(c) Sealed source type:

(d) Strength: curies

(e) Serial No.:

Section IV PERMIT APPROVAL

Reviewed by Doosan Manager: ………………………………………………………… Signature …………………………… Date …….../…..…./……..

Comments.

DHI-EHS-HSM-031 (March 2014), Page 16 of 21

Section IV PERMIT APPROVAL

Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. On / / . It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected
from the main source of power supply.

Name of the Doosan EHS Manager:………………………………..…………………….. Signature …………………………… Date …….../…..…./……..

Comments

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Project Doosan Civil/ Doosan Electrical/ Doosan QA/ QC
( )
Director Architecture Manager Mechanical Manager Manager
Subcontractor Subcontractor Area
( ) ( ) Security
Site Manager Manger

DHI-EHS-HSM-031 (March 2014), Page 17 of 21

Attachment 8
WORKING OVER WATER (MARINE) WORK PERMIT
Project Name Date:

Location(s)

Section – I
Permit Receiver (SC)
Engineer Responsible (DHI)
Safety In charge (SC)
Safety Advisor on Site (DHI)
Section – II
PERMIT ISSUE DETAILS
DETAILS OF THE PERMIT RECIVER (SC = Sub Contractor, DHI = DOOSAN)
Contact Number
Contact Number
Contact Number
Contact Number
PERMIT VALIDATIONS
Date ____________________ Time ________________ NO EXTENSION WILL BE

PERMIT EXPIRY DETAILS Date ____________________ Time ________________ GIVEN ON THIS PERMIT
Permit Contents: 1) Permit to Marine Work Permit (Two copies one for site one for EHS file)
2) Method Statement and JSEA (Copy for Site)
3) Personnel Training Record Sheet (To be placed in EHS file)
Section – III PREREQUISITE (Work May be stopped if one of the following is not complied with)
Yes/ Yes/
 for YES and X for No NA  for YES and X for No NA
No No
A Approved Work Method Statement attached? H Life boat with crew standing by?
B Wind/Waves checked? I Fist aid kit available?
C Visibility checked? J Oil/fuel spillage prevention provided?
D Crane operator possesses a valide certificate? K Fire extingushers maintained operable?
E Hoist wire and clam checked? L Search light furnished for emergency?
F Emergency communication maintained/available? M Sufficient food stocks & drinking water reserved?
G Life Jackets available and worn by all crew? N Other necessary precautions?
Special Note.

Section IV PERMIT APPROVAL

Reviewed by Doosan Manager: ………………………………………………………… Signature …………………………… Date …….../…..…./……..

Comments.

Section IV PERMIT APPROVAL

DHI-EHS-HSM-031 (March 2014), Page 18 of 21

Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. On / / . It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected
from the main source of power supply.

Name of the Doosan EHS Manager:………………………………..…………………….. Signature …………………………… Date …….../…..…./……..

Comments

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Project Doosan Civil/ Doosan Electrical/ Doosan QA/ QC
( )
Director Architecture Manager Mechanical Manager Manager
Subcontractor Subcontractor Area
( ) ( ) Security
Site Manager Manger

DHI-EHS-HSM-031 (March 2014), Page 19 of 21

Attachment 9
DIVING WORK PERMIT
Project Name Date:

Location(s)

Section – I
Permit Receiver (SC)
Engineer Responsible (DHI)
Safety In charge (SC)
Safety Advisor on Site (DHI)
Section – II
PERMIT ISSUE DETAILS
DETAILS OF THE PERMIT RECIVER (SC = Sub Contractor, DHI = DOOSAN)
Contact Number
Contact Number
Contact Number
Contact Number
PERMIT VALIDATIONS
Date ____________________ Time ________________ NO EXTENSION WILL BE

PERMIT EXPIRY DETAILS Date ____________________ Time ________________ GIVEN ON THIS PERMIT
Permit Contents: 1) Permit to Diving Work Permit (Two copies one for site one for EHS file)
2) Method Statement and JSEA (Copy for Site)
3) Personnel Training Record Sheet (To be placed in EHS file)
Section – III PREREQUISITE (Work May be stopped if one of the following is not complied with)
Yes/ Yes/
 for YES and X for No NA  for YES and X for No NA
No No
A Approved Work Method Statement attached? K Two way communication established and known?
B Wind/Waves checked? L Emergency communication maintained available?
C Velocity and direction of the current confirmed? M Emergency transportation maintained ready?
D In-water Visibility checked? N Operational Compression chamber available?
E Diving equipment checked? O Compressor for respiratory air chcecked?
F Depth guage properly calibrated as required? P Respiratory air clean device provided?
An air flow meter provided and properly
G Diving record maintained? Q
function?
H Diving dresses free of defects? R Watch man (look out) assigned and maintained
I Dive Logs available? S Search light furnished for emergency
J Stand by Diver dressed? T Life Jackets available and worn by all crew
Special Note.

Section IV PERMIT APPROVAL

Reviewed by Doosan Manager: ………………………………………………………… Signature …………………………… Date …….../…..…./……..

Comments.

DHI-EHS-HSM-031 (March 2014), Page 20 of 21

Section IV PERMIT APPROVAL

Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. On / / . It has to be ensured that the employee executing the Job has a copy of the permit at all times during
work. No equipments shall be left unattended at any time whatsoever the reason may be. Prior to any accessory replacement the tool must be disconnected
from the main source of power supply.

Name of the Doosan EHS Manager:………………………………..…………………….. Signature …………………………… Date …….../…..…./……..

Comments

PERMIT COPY DISTRIBUTION (tick appropriate boxes):

Project Doosan Civil/ Doosan Electrical/ Doosan QA/ QC
( )
Director Architecture Manager Mechanical Manager Manager
Subcontractor Subcontractor Area
( ) ( ) Security
Site Manager Manger

DHI-EHS-HSM-031 (March 2014), Page 21 of 21