Line Breaking Permit

Permit form for authorizing the opening of process piping or equipment that may contain hazardous material, with verification of isolation, draining, depressurization, and safe work controls before the line is broken.

Permit Overview

• Permit title
• Work order or job number
• Work area / unit / asset
• Planned start date
• Estimated permit duration (hours)

Line and Hazard Identification

• System / line / equipment description
• Material or service in the line
• Known or suspected hazards
• Could hazardous material still be present?

Isolation and Energy Control

• Primary isolation method
• Isolation verified in the field
• Line has been drained and depressurized
• Line has been vented or purged as needed
• Other energy sources controlled

Work Controls and PPE

• Required PPE
• Spill containment and cleanup materials are ready
• Work area is isolated and barricaded
• Required monitoring before and during opening

Personnel and Communication

• Permit requestor
• Supervisor / issuer
• Number of authorized workers
• Standby person required
• Emergency communication method

Authorization and Closeout

• Exceptions, deviations, or additional precautions
• Permit approved for line breaking
• Approver name
• Approval date and time
• Closeout notes