1. Hot Work Permit  Meraux Refinery   Yes  N/A Meraux Refinery
Permit Number:
Information to be completed by Permit 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 Operator or 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 Y
Valves-Closed/Tagged/Chained/Locked
Orange Vest
Equipment Opened/Depressurized
Equipment Decontamination
Signal Horn
Blinded/Disconnected
Water Washed
Fire Extinguisher
Electrically locked / tagged out
N2 Purged
Area “Wet Down”
Field Test / Attempt to Energize-start
Steamed
Contained Sparks
Blinds Verified & Blind-List initialed
Other
Sumps-Drains Covered
Lighting
Clean-up oil in area
120 V w/ GFCI
Additional Fire Equipment
Additional Standby
Job Hazards Y
Standard Controls
PPE
Req’d
Access & Egress
Housekeeping, Walkways, Stairs
Manual Handling / Lifting
Assessment & lifting equipment
Standard (SSP-0011)
Activities of Others
Communications, Barriers, Permit
Moving Parts
Covers, Isolation, & Maintenance
Full Face Shield
Y -- N
Chemical /Fuel Exposure
MSDS Review, PPE
Overhead Hazards
Labelling, Isolation, & Barriers
Goggles
Vehicle Entry
Procedures, Barriers, & Permit
Sharp Edges
Covers, PPE, & Equipment Inspections
Hearing Protection
Electricity
Isolation, LOTO
Slips, Trips & Falls
Housekeeping, & PPE
Fall Protection
Flammable Vapors / liquid
Gas Testing & Isolation
Static Electricity
Grounding,
Rubber /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
Spillage to Ground
Secondary Containment
Hot Liquid
Procedures & PPE
Respirator Full Face
Spillage to Water
Containment / Booms
Working at Height
Scaffolding & Fall Protection / Harness
Supplied Air
Working Over Water
Life Jacket, & Safety Boat,
Personal H2S monitor
Mechanical Lifting
Barriers / Lift Procedures
Other
Specific Hazards:
Additional Controls and/or Special Instructions No
Date
Time
Oxygen
LEL
H2S CO
Benzene
Other
Serial #
Calibrated?
Meraux Qualified Person: 1  2 3 4
Signing this Work Permit signifies the job site has been inspected by the Permit Issuer and Permit 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.
All Signatures are Required PRIOR to Hot Work Start.
Time Start
Time Expires
Authorized
Print Name
Signature
Date
Permit Holder
Operator
Chief 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
Operator
Chief 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
The Permit Holder completes this section of the permit prior to meeting wit permit issuer.
Check if Meraux personnel doing work
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 – then make any relevant comments in this area.
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.
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.
These names, signatures and date must be complete and the Start and End time for the permit set (above) prior to work start.
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.