Hot Work Permit s1

Permit No This Hot Works Permit Application is applicable to all hot works carried out on lands within the Port of Townsville. Hot Work Permit Application

Annual permit required Yes  No 

Applicant Name: Applicant Organisation: Telephone No: Fax No: Email contact: Precise Location of Hot work: Yes  No  Marine Services must be notified prior to Hot Works Is Hot Work within a Landside Restricted Zone (LRZ) commencing in a gazetted LRZ (active or otherwise) Permit valid from: Time: Date: Permit completion: Time: Date: Description of work: Welding  Grinding  Cutting  Gouging  Brazing  Details of Public Liability Insurance (refer to clause 12 of Terms and Conditions) If you answer NO to any of the following questions and can’t address the issue yourself, you must stop and seek advice from your Supervisor. Hot Work Checklist Note: This application may be rejected if the Hot Work Checklist is not completed. Yes No N/A Is JSEA or Take 5 available and has it been communicated to the work party? Are smoke detectors in the immediate vicinity isolated or capped? Is the area cleared and/or free of all readily combustible materials e.g. dry grass, leaves, paper etc If unable to remove, have such items been covered or protected by non-combustible material? Has a responsible person been designated to conduct a periodic fire watch while work is being performed and for a period of at least 60 minutes after work is completed? Where flame, arc-welding, grinding or cutting operations are being carried out, are screens, shields or other devices proposed to be used to shield spray? Is a fully charged 9 kg dry powder (or equivalent equipment) proposed to be positioned at the site of the hot works? Is there any other fire fighting equipment (e.g. hose reel) in the area accessible and its location known by the person/s performing the hot work? Is the applicant aware of the requirement to notify Marine Services prior to commencing Hot Work within a Landside restricted Zone? Have you informed the Terminal Operator of your intention to carry out Hot Work? Applicant Declaration I / We have read the Terms & Conditions printed on the reverse and agree to abide by the conditions of this permit Applicant Name: Signature: Date: APPLICANT TO FORWARD TO MARINE SERVICES TOWER ON FAX 07 4771 4493 Permit to Proceed (Office Use Only) Port of Townsville Limited’s (POTL) Manager Maintenance (MM) / or delegate is the approving authority for all land based Hot Work Permits. If hot work is being conducted within a Landside restricted Zone, Manager Marine Services (MMS) / or delegate will be required to provide an authority to proceed. MMS Name: Signature: Date: Approved  Not Approved  Remarks/ Conditions of Issue:

MM Name: Signature: Date: Approved  Not Approved  Remarks / Conditions of Issue:

© Port of Townsville Limited Document Type Template/ Form Document No. POT 311 A.C.N. 130 077 673 Only electronic copy on server is controlled. To ensure paper copy is Revision 8 current, check revision number against entry in Qudos - Master Document Date 31/03/2015 List Page 1 of 2 Conditions of Permit Issue

This permit is issued subject to the Terms and Conditions printed below: 1. This permit is only valid for the period specified on the application. 2. This permit is only valid for the scope of works described and approved in this application. 3. This permit is to be retained at the worksite at all times whilst work is underway. 4. Each and every item listed on this permit shall be complied with by the Permit Holder at all times during the carrying out of the permitted works. 5. Where works are to be carried out within a Landside Restricted Zone, Marine Services must be notified not less than 24 hours prior to commencement. 6. This permit does not detract from the Permit Holder’s responsibility to work safely and in accordance with Work Health and Safety Act 2011 (Qld). 7. The Permit Holder must at all times comply with the requirements (where applicable) of AS1674.1- 1997 ‘Safety in Welding and Allied Processes’. 8. Appropriate personal protective equipment must be worn at all times by all people in close proximity to the work area. 9. Barricades and Warning Signage must be displayed at all times when conducting hot work. 10. Auditing of Permit Holders will be conducted by POTL’s Safety Manager / or delegate, and unless personal injury or property damage is suspected, issues regarding non compliance of the Permit Holder with the permit conditions will be directed through the Permit Holder’s company and not to the Permit Holder directly. 11. The Permit Holder performs the works at its own sole risk and indemnifies POTL (including its officers, and employees) against all claims and losses sustained or incurred by any person in respect of personal injury or death or loss of or damage to any property, arising directly or indirectly out of or as a consequence of the Permit Holder performing the works (subject to a reduction to the extent of any contribution by POTL). 12. Before commencing the works, the Permit Holder shall effect and maintain for the duration of the works a public liability insurance policy for an amount in respect of any one occurrence of not less than $20 million. 13. In the event of any Emergency, the Contractor shall comply with the directions of POTL. 14. In case of an emergency, contact 000 and then Marine Services Tower on 4781 1684 or VHF Ch 16.

© Port of Townsville Limited Document Type Template/ Form Document No. POT 311 A.C.N. 130 077 673 Only electronic copy on server is controlled. To ensure paper copy is Revision 8 current, check revision number against entry in Qudos - Master Document Date 31/03/2015 List Page 2 of 2