1. Hot Work Permit  Meraux Refinery   Yes  N/A Meraux Refinery
Permit Number:
Information to be completed by Permit Requestor/Holder
Company:
 Meraux Refinery
Contractor Name 
Area/Unit
Permit Holder:
Tools/Equipment to be used:
Equipment #
# Persons: Work Order #:
Hand tools
Lift trucks
Double Insulated Electric
Other:
Scope of Proposed Task:
Please initial that the Scope of work is clear and understood. Permit Holder: Permit issuer:
Information to be completed by Permit Issuer. (Must be Chief Operator)
Previous Product
in Equipment:
MSDS Checked
 Yes  N/A
Additional
PPE Required?
Equipment Pre-Work
Req’d
Done
Area Preparation
LOTO Procedures Followed
Y -- N
Lock Box Number:
Trained Fire-Watch
Blinded/Disconnected
Decontamination
Orange Vest
Equipment Opened/Depressurized
Water Washed
Signal Horn
Valves-Closed/Tagged/Chained/Locked
N2 Purged
Fire Extinguisher
Deenergized Electrical Systems
Steamed
Area “Wet Down”
Electrically Locked/tagged out
Other
Sumps-drains covered
Field Test / Attempt to Energize-start
Radioactive Sources Secure
Contained Sparks
Blinds Verified & Blind-List initialed
120V Electrical equip GFCI
Clean-up Oil in Area
Additional Fire Equipment
Additional Standby
Job Hazards Y
Standard Controls
PPE
Req’d
Static Electricity
Grounding,
Manual Handling / Lifting
Assessment & lifting equipment
Standard (SSP-0011)
Y -- N
Slips, Trips & Falls
Housekeeping, & PPE
Moving Parts
Covers, Isolation, & Maintenance
Full Face Shield
Chemical /Fuel Exposure
MSDS Review, PPE
Overhead Hazards
Labelling, Isolation, & Barriers
Goggles
Vehicle Entry in the unit?
Procedures, Barriers, & Permit
Sharp Edges
Covers, PPE, & Equipment Inspections
Hearing Protection
Electricity
Isolation, LOTO, GFCI
Activities of Others
Communications, Barriers, Permit
Fall Protection
Flammable Vapors / liquid
Gas Testing & Isolation
Access & Egress
Housekeeping, Walkways, Stairs
Leather Gloves
Fumes & Dust
Respirator / Eye Protection
Trapped Pressure
Venting, Draining, & PPE
Rubber Gloves
Hot Surfaces
Insulation / Barriers / PPE
Vehicle Traffic
Hi-Vis Clothing, Speed Limit, & Signs
Non Permeable Suit
Toxic Vapors / Liquids
Underground Hazards
CAT Testing, Labelling, & Barriers
Respirator ½ face
Excavation
Excavation Checklist
Hot Liquid
Procedures & PPE
Respirator Full Face
Weather Extremes
Schedule, breaks.
Working at Height
Scaffolding & Fall Protection / Harness
Filter Type:
Spillage to Ground
Secondary Containment
Working Over Water
Life Jacket, & Safety Boat,
Supplied Air
Spillage to Water
Containment / Booms
Mechanical Lifting
Barriers / Lift Procedures
Personal H2S monitor
Welding Apparell
Specific Hazards:
Additional Controls and/or Special Instructions
Signing this Hot Work Permit signifies the job site has been inspected by the Permit Issuer and Permit Requester/ Holder, the area is prepared, and each individual has agreed to comply with the conditions of this permit.
The Permit is valid through the end of the current work shift (start and end times below) and may be extended into the next shift if necessary.
Test 1
Test 2
Test 3
Test 4
Date
Time
Oxygen
LEL
H2S CO
Benzene
Other
Serial #
Calibrated?
Initial -- Meraux Qualified Person
All Signatures are Required PRIOR to Hot Work Start.
Time Start
Time Expires
Authorized
Print Name
Signature
Date
Permit Holder
Permit Issuer
(Chief Operator)
Unit Operator
Fire Watch
All Signatures are Required PRIOR to EXTENDING permit into the following shift.
Time Start
Time Expires
Authorized
Print Name
Signature
Date
Permit Holder
Permit Issuer
(Chief Operator)
Unit Operator
Fire Watch
Permit End
Work Completed
Work Site in Safe Condition
Print Name
Signature
Date
Time
Permit Holder
Yes No
Yes  No
Unit Operator

2. Permit Number will be pre-printed on form
Check if Meraux personnel doing work
The Permit Holder completes this section of the permit prior to meeting wit permit issuer.
Check and indicate Contractor Name for contractor work
Person responsible for directly supervising the work.
How many will be involved performing work
Indicate work order numbers
The Permit Holder should describe the scope of work to be completed in this area.
List tools & equipment to be used.
Indicate product last in vessel so proper PPE can be assessed..
<< Indicate if the MSDS was checked for the previous product in the vessel and any additional PPE required.
The Permit Issuer and Permit Holder work through this section to ensure that:
1 – all Equipment Pre-Work area are checked to indicate what is REQUIRED (Req’d)
2 – to ensure that all REQUIRED Pre-Work is actually DONE
The permit issuer and Permit Holder also ensure area preparation is required and Done for Bottle Watch or Low Energy Work.
The Permit Issuer and Permit Holder also inspect the area for Job Hazards. In this area if a Job Hazard exists the box should be checked. Standard Controls or other appropriate measures should be taken to ensure the area is safe for work.
Also – potential Environmental impacts are noted below:
Based on the work and hazards – specific required PPE should be Identified for the permitted work.
Identify any additional or specific Hazards of explanations of certain above information.
Clarify additional controls or special instructions for the work..
A Meraux employee (or designated contractor during turnaround events) who is qualified to do air testing must test the work area prior any confined space work and must take additional samples during the course of the work. A separate form for tracking confined space entry and other required will also be required.
These names, signatures and date must be complete and the Start and End time for the permit set (above) prior to work start.
If, at the end of the shift, it is necessary to extend the permit, the on-coming Permit Holder and Issuer must review the area to ensure conditions have not changed and re sign the permit with start and end times.
When the work is complete the Permit Holder and the Unit Operator should review the work and indicate whether it is complete and the site is in Safe condition – then print and sign their name, date and time on the form.