|
W.O.# NWI-230174
<br />T�nknalog,-y Inc
<br />IC501 'N10" -C 5,wtc 4(ItIAunm, TX
<br />JOB CLEARANCE FORM &
<br />SITE SAFETY CHECKLIST — ON's
<br />0 Cust Ref#: 15092506
<br />Rc� D
<br />Site Natner#:(.&Ve�,tq WO P
<br />e
<br />Arnvaj Time Davarture Time aMrj on Si[ Elie
<br />16
<br />S of 1 Tasks P orm v, ij -115 1�te, `or I: wxs.
<br />Z16,
<br />m, or PRrrs F1.m%,,VeC
<br />a,(iom3 required: equiY-rrcrscia',Pd aur.,;re.M:
<br />11 i" 6k 11rufa V -
<br />PPE PERSONAL PROTECTME EQUYPMENT REQUIRED iCheck 4W)"s used or mark - ifnot applicatUo
<br />Ifety Vest salo.- F Gasses Gloves
<br />Stes� 70e 500!.3 S,, Gor.g r.,s Ham, Hat Other
<br />PRE-TEST PROCEDURES (Check each item com.oleted or mark ifnota oclicable)
<br />1.Dscuss safely De�rsc ri— %earest h 1spil,a]:
<br />2. prio, to fwei de�lweri as tt-,e- UST system must t)e placed back into wo&ng arder.
<br />3 Secure entire W0.7� area with LMMCZde3 �,Cones. fa4s, and caution tape, pennan stags: or other perimeter guwd).
<br />liirt)-lement
<br />4 place fire -�xtin gu € s ne -s and "No Srrtoking"s;rgns,n thework area,
<br />Lockout!Tagoul.per API 1646,,when acc-ess�fiqproduct piping during tasks)I a - , - ' 'Out cevte
<br />potic-ble �-- �1,11),,,eli a�sat":ed �unaq mst(s�� e the �rnoit 13reakeris witti izci s an re
<br />Close bal0 "3 ve"n tar ,a'=ve -an ;-,%X!UV nirX'n. D;sot,,,�er,,,,�le�Tf:Qa:'bayo�,,et'co-�)�ne-,Irr, from
<br />SIGN IN
<br />General Safety Checks:
<br />ve n --;eafan,-e farm, wilh teKwiiola
<br />POST-TEST PROCEDURES (Check each item completed or mark — it nor aMicab)e
<br />Remove all -Lo--kout"TacIout- de,4ces
<br />P -v7 --,s Fnvoiv there are no leas: Impact Valve Test Ports under dispensers
<br />L"rte Threads on STID's Functional Element's & Reflef Screws
<br />3. Il a 1i eaa aI test plugs &IJ.Iak detct.1s that were servir-ea,
<br />Count LD threads: L9 ,,_L2 -- L3— L4--.- L5 L6
<br />CCo er�T ATG probes, Sensors: & caps
<br />4 Cne,:k m onerAS op
<br />Sail floa's, ,v breaks & caps
<br />MBi & POS
<br />Containment sumps are cry enser.5 operational
<br />0s$Pense.- pdrlef5 are repeceO Crop tu66-S--Wdapters & caps
<br />Leak detectors &vent tubes II covers
<br />Monilonn-g System is oPeratiOMi Shear valves are open
<br />diptivir- III Ivu at IiU mwilfoid valvcS Siphor l{nes and manifold valves
<br />STP fttirtgs and bayonet conre,:1 D,� Vents :nut cat)"ed, plugged or isolalec^_')
<br />SIGN OUT S Operator V�erifi cation ofWork {OVF)
<br />3
<br />Me
<br />-os,
<br />of
<br />I
<br />t"f)M1-A%S
<br />00 V
<br />�At6l 5
<br />"I;JIn '09S Ail Ri
<br />w-;i-
<br />M
<br />
|