Mid West Ports Authority
Permit
Number:
F4.1d Hot Work Permit
Hot work is work such as welding, thermal or oxygen cutting, heating and other fire-producing or spark-producing operations that may increase the
risk of fire and explosion.
APPLICANT DETAILS
Full Name:
Company:
Email Address:
24 hr Contact No.:
Start Date/Time:
Completion Date/Time:
REASON FOR HOT WORK
LOCATION OF HOT WORK
WORK AREA
TYPE OF HOT WORK
Burn
Weld
Gouging
Grinding
Cutting
REQUIREMENTS CHECKLIST
Isolation of associated plant has been completed.
Work area has been isolated, barricaded, screened off.
A Job Safety and Environment Analysis (JSEA) has been completed and signed by all operators. The JSEA is
to be provided to all adjacent leaseholders and operators, as well as held on site at all times during the works.
Is work area a confined space, if so, a Confined Space Entry Permit (F4.1e) is to be completed.
An Emergency Evacuation Plan has been agreed which includes emergency contacts.
All fire equipment is available in the work area:
Fire Extinguisher
Fire Hose
Fire Blanket
All Operators associated with the works are licensed and/or competent to carry out the work.
All applicable equipment and services are certified and meet all current legislation, regulations and standards.
WORKS ADJACENT TO A BERTH
Are the works adjacent to a berth, near bollards or close to mooring ropes? If yes, see mandatory
notes.
Yes
No
I have read and understood the dangers/hazards associated with working close to moored ships as highlighted
in the MWPA Induction.
WORKS WITHIN 5 M OF FUEL PIPELINE
Are the works within 5 m of a fuel facility or pipeline? If yes, see mandatory comments
Yes
No
If the work is within 5 m of a fuel facility or pipeline the issuing MWPA Wharf Supervisor must discuss the application
with the Licenced Pipeline Operator* prior to the permit being issued. Record of communication.
* Licenced Pipeline Operators:
B5&6 fuel facility including Marine Terrace and Port Way valve enclosure: Shell 0428 115 068, BP 0418 211 288
FBH fuel facility; Baileys Marine Fuels Australia
Contact Name:
Company:
Wharf Supervisor:
Signature:
Uncontrolled when printed or in hard copy
F4.1d – v3 – 19/05/2014
Date:
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Mid West Ports Authority
Permit
Number:
F4.1d Hot Work Permit
MWPA INTERNAL ASSESSMENT
MWPA Check
Name:
Signature:
Rejected – Revise and Resubmit
Date:
Approved/Additional Mandatory Conditions
ACCEPTANCE OF CONDITIONS/REQUIREMENTS
By signing this document, the undersigned has read, understood and accepted the terms and conditions of this
application and declares that all information given is true and accurate.
Applicant Name:
Signature:
Date:
APPROVAL ISSUED ONLY WHEN SIGNED BY AUTHORISED MWPA REPRESENTATIVE AND PROCESSED BY
THE DUTY WHARF SUPERVISOR
MWPA FINAL APPROVAL
Approved by:
Maintenance Supervisor
Duty Wharf Supervisor
Operations Supervisor
Approvers
Name:
Signature:
Date:
Signature:
Date:
Processed by Duty Wharf Supervisor:
Name:
OFFICE USE ONLY
Recorded in Work Permits Register
Date:
Completion advised and site checked
Date:
Application closed
Date:
MWPA TERMS AND CONDITIONS
1
Applicants are responsible for ensuring they have a BHF Authority to Work Permit (F4.1m) which can be obtained through the
Operations Supervisor [email protected] or 0407 797 311 when working on or under Berths 4 and 5 or in the BHF. When
working on or under Berth 7, authorisation must be provided by Karara Mining Limited.
2
To ensure timely approval, the application must be lodged within 2 days prior to commencement of the work.
3
No work can commence until a signed approval from MWPA has been received (in hard copy or via email) and any additional
conditions/requirements have been accepted.
4
Consideration should be given to hot work in areas which contain flammable liquids or build-up of flammable solids where there is a
risk of fire or explosion.
5
Any safety or environmental incidents, or damage during works must be reported to MWPA immediately. After hours please call the
Duty Wharf Supervisor on 9964 0410. With regard to such incidents, you are responsible for making good the site and any other
affected area to the satisfaction of the MWPA.
6
All personnel accessing MWPA sites are required to have completed the MWPA induction. Within the secure zone, individuals are
required to carry their own Maritime Security Identification Card (MSIC) at all times. A visitor’s pass may be obtained, although all
visitors must be escorted at all times by a holder of a current MSIC.
7
Any failure to gain approval for work, or failure to comply with MWPAs OHS-GUI-001 Contractor and Worker Requirements Handbook
or Procedure 4.1 Permit to Work, may result in a penalty or permission to enter MWPA sites being withdrawn until all MWPA
requirements are met.
8
This permit is to be held on site at all times during the works.
Should you have any queries, please contact MWPA Duty Wharf Supervisor on 9964 0510
Completed permits should be emailed to [email protected].
Custodian:
OHS Officer
Uncontrolled when printed or in hard copy
F4.1d – v3 – 19/05/2014
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