S06 - Amendment 0008 - ATT 13 - Hot Tapping Permit.pdf

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HOT TAP WORK PERMIT - EQUIPMENT IN SERVICE

Part I: TO BE COMPLETED BY THE REQUESTER:

Note: Separate request required for each individual hot tap. Job/Work Order Number_____________

(1) Description of piping/equipment/job location:

(2) Description of work to be done:

(3) Justification of why the piping/equipment cannot be de-energized through explanation of continuity of service is essential & shutdown impractical (Note: Inconvenience is not a factor):

Requestor/Title ___________________ Date _______________

Part II: TO BE COMPLETED BY THE QUALIFIED PERSONS DOING THE WORK:

(1) Have personnel executing the “Hot Tap” procedure provided documentation of the necessary level of training to meet their responsibilities associated with the procedure:

YES / NO (circle)

(2) Competent Person oversight is available and will be present during the hot tapping:

YES / NO (circle)

(3) Welding Required: YES / NO (circle)

Hot Work permit was obtained and includes a specific Hot Tapping Welding Safety Task Review (API-2201, Appendix C): YES / NO (circle)

(4) Emergency Action Plan developed (i.e.API-2201, Appendix D): YES / NO (circle)

(5) Necessary personal protective equipment to safely perform the assigned task (FR Clothing, Welding Helmet, Gloves, etc)

(6) Means employed to restrict the access of unqualified persons from the work area:

(7) Evidence of completion of a Job Briefing including discussion of any job-related hazards:

(8) Multi-Gas Meter is available, calibrated, and will be used for monitoring: YES / NO (circle)

(9) Do you agree the above described work can be done safely? YES / NO (circle: If no return to requester)

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Contractor/ VA Operation Supervisor(s) Date COR/VA Project Engineer Date

Part III: RECOMMENDATION(S) TO PERFORM THE WORK WHILE EQUIPMENT IS IN

SERVICE:

Chief of Engineering Date Facility Safety Officer Date

Part IV: APPROVAL TO PERFORM THE WORK WHILE EQUIPMENT IS IN SERVICE:

Medical Center Director Date

TO BE FILLED OUT BY THE REQUESTER

TYPE OF PROPOSED INSTALLATION

HEADER OR VESSEL INFORMATION

LINE SIZE (in.)_________________ _ METALLURGY_________________

OPERATING PRESSURE__________ PSIG TEMPERATURE ___________ F

PROCESS DESCRIPTION _________________________________________

BRANCH CONNECTION INFORMATION

LINE SIZE (in.)_________________ _ FLANGE RATING_______________ PSI

OPERATING PRESSURE__________ METALLURGY _________________

INITIATOR _____________________ DATE _________________________

Provide location sketch of the proposed hot tap. The hot tap location must have scaffolding (where required for access), insulation must be removed and the equipment must be marked for the exact hot tap location prior to notifying Pressure Equipment Inspection.

TO BE FILLED OUT BY THE CONTRACTOR/VA PROJECT ENGINEER (COMPETENT

PERSON) AND PRESSURE EQUIPMENT ENGINEER (QUALIFIED PERSON)

WALL THICKNESS AT HOT TAP LOCATION _____(in.) DETERMINED BY: __________

DATE: ________

WELD DETAIL NUMBER:

1. PROCEDURE ______ X-RAY ______

2. PROCEDURE ______ X-RAY ______

3. PROCEDURE ______ X-RAY ______

INSPECTOR: ______________________

TESTS REQUIRED:

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(A) NOZZLE ______________________ PSIG MEDIUM __________________

(B) REINFORCING PAD ____________ PSIG MEDIUM __________________

(C) BLOCK VALVE: HYDROSTATIC SEAT EACH SIDE AT ____________ PSIG

AREA INSPECTOR ________________ DATE ____________

PRESSURE EQUIPMENT ENGINEER___________________ DATE ___________

TO BE FILLED OUT BY THE CONTRACTOR PERFORMING THE HOT TAP

HOT TAP MACHINE:

MAKE _____________ MACHINE RATING: _____________ PSIG AT : ___________ F

MODEL __________________ PRESSURE TESTED AT _________ PSIG

SERIAL NO. __________________________ BY _____________________DATE __________

CONTRACTOR REPRESENTATIVE ______________________________DATE ___________

HOT TAPPING