Tanker Vessel Gas Freeing Work Permit
1. Permit Details
Permit No.:
Date/Time Issued:
Valid Until:
Vessel Name:
IMO No.:
Location:
Name of Person in Charge:
Department:
2. Description of Work
3. Area to be Gas Freed
4. Associated Hazards
5. Personal Protective Equipment (PPE) Required
6. Gas Testing Results
Location
Tester
O
2
(%)
LEL (%)
H
2
S (ppm)
CO (ppm)
Date/Time
7. Checklist Before Commencing Work
8. Permit Authorization
Person Issuing Permit
Signature:
Name:
Date/Time:
Person Receiving Permit
Signature:
Name:
Date/Time:
9. Permit Cancellation/Completion
Work completed on (date/time):
Remarks:
Signature (Person in Charge):