HOT WORK PERMIT

Permit No. Job To be done

Section of Plant ____________________________________ Equipment Name & Tag Number ___________________ Permit may be issued to Mr. ______________________________ of deptt. / contractor___________________________ to carry out the ________________________________________________________________ Job, date_____________ from ________ hrs to __________hrs.

Equipment to be used: (tick where required)

Electric Arc/Organ Welding

Oxy Acetylene Torch

Grinding

CHECKILIST OF SAFETY MEASURES

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Tick ( ) as applicable
Yes Not Reqd

Risk assessment completed All combustible material removed Safe access to job provided. Safe approach/scaffold provided Tank/Pipeline/Containers containing flammable material completely emptied, Flushed with water and purged properly Lines disconnected/blanked completely All necessary arrangement made to prevent spreading of sparks Fire fighting arrangements made Considered hazard from other routine/non routine operations & concern person alerted. Welding machine cables, holder etc. and hoses, regulators of gas cutting set are in good condition. Hazards associated with the job and safety measures told to workers Additional attachments as Isolation & Lockout/Working at Height, if yes. Permit No.__________

Persons who will undertake the work: S.No. 1. 2. 3. 4. 5. Name of Employee PPES Used Signature

Above conditions have been checked personally and equipment is fit to start the work

Requisitioned By
INITIATOR
(The deptt. who will carry out the job) Signature: Name & Designation:

PLANT
(The deptt.where the work will be carried out)

Signature: Name & Designation

Date

Date

Safety & Fire Department

Name Signature: Designation:

Recipient
I have read this hot work permit and have had the hazards and precautions explained to me. I undertake to comply with the provisions of the clearance and to explain those provisions to the persons working with me on the job

Signature of Recipient:

Validity of extension Date Time From To Signature Initiator

Job Supervisor

Plant

Safety