🔧 Process Safety Management

Process Opening & Blinding Permit

Line Breaking & Blind Installation/Removal

⚠️ CAUTION: Opening process lines or equipment may release hazardous materials under pressure. Ensure proper isolation, depressurization, and PPE before breaking containment.

📋 Permit Information

District / Base *

Date *

Start Time *

Expected End Time *

Equipment/Line Description *

Equipment ID/P&ID Reference

Work Location *

Work Description *

👥 Personnel

Permit Issuer *

Authorized Worker *

🔩 Opening & Blind Details

Opening Type *

Blind Type *

Blind Location/Tag

Hazardous Contents *

🔒 Isolation & Preparation

System Isolated?

LOTO Applied?

Depressurized?

Drained?

Purged/Vented?

Residual Hazard Present?

LOTO Permit Number (if applicable)

🌡️ Atmospheric Testing

Atmosphere Tested?

O₂ Reading (%)

LEL Reading (%)

H₂S Reading (ppm)

✅ Pre-Work Checklist

Bolts loosened gradually?

PPE donned?

Containment in place?

Drip pan under break point?

Spill kit available?

🦺 Required PPE

Face Shield

Chemical Suit

Chemical Gloves

Safety Glasses

FR Clothing

✍️ Authorization Signatures

Permit Issuer Signature *

Authorized Worker Signature *

AnthroSafe™ Field Driven Safety