Date: HOT WORK PERMIT – KRI PTW No:

Company doing hot work: Job Site/Location:

Describe task to be performed:

List hot work equipment to be used (Ignition Sources): List previous / existing contents of equipment and materials
(Fuel Sources):

ATMOSPHERIC MONITORING
To be completed if conducting hot work in a Classified Area or for conducting hot work on equipment that previously contained
hydrocarbons.
Type Serial Number Cal Due Pre-Use Bump QGT Initials
Meter Inspection & #1: days ☐ OK
Function Check #2: days ☐ OK
#3: days ☐ OK
Time O2 LEL H2S CO Other: Other: Meter
19.5% – TWA : <50 QGT Initial
23.5% < 10 % <10ppm ppm Number

Initial Gas Testing conducted within the hot work area and out to a 50ft radius of the hot work: YES ☐
See attached gas test log for additional results ☐ NA ☐
Follow-Up Gas Testing Requirements QGT Initials
LEL =0% ☐ Gas Tester determines frequency
Frequency (based on potential hazards, change in conditions, odors)
of tests
LEL >0% and <10% ☐Continuous monitoring required Active☐ Passive ☐
Documentation NA ☐ 15mins ☐ 30mins ☐ 1hr ☐ 2hr ☐ ☐Other:
NOTE: If scrap pipe will be generated during the job, ensure that material is NORM tested, marked and documented prior to
removing from location.
QUALIFIED GAS TESTER SIGNATURES
Initial Gas Tester Name: Signature:
Follow-Up Gas Tester Name: Signature:
MINIMUM PRECAUTIONS & SAFEGUARDS REQUIRED Permit
Approver
If conducting hot work on equipment that is in-service or has YES☐ NA☐ NA ☐
previously contained hydrocarbons, has positive physical isolation
been achieved?
Positive physical isolation (PPI) achieved prior to conducting hot work YES☐ NA☐
Isolation of on piping:
Hazardous Energy If opening an electrical enclosure in a classified area, has electrical YES ☐ NA☐
(IHE) power been de-energized and isolated?
IHE Permit is required for this job? YES ☐ NO☐
NOTE: IHE applies to all energy types, i.e., GRAVITY, CHEMICAL…
not just PRESSURE and ELECTRICAL. Use Hazard Wheel to
identify all energy types.
How has the open flame hot work area been visually identified? NA ☐
Barricades ☐Signage ☐ Cones/Tape ☐Gate ☐Observer ☐Other:
Tools/equipment to be used in activity have been inspected: YES☐ NA ☐
Tool/Equipment ☐ Ext. Cords/Welding Leads ☐Compressed Gas Cylinder Secure
Inspection ☐Oxy/Act Hoses ☐Other (not listed on PTW):
 Spark Flammables/Combustibles removed or protected within 50’ of hot YES☐ NA ☐
work activity? (Required for open flame HW.)
Control/Protecting
Adjacent If not removed, method(s) of protecting flammable/combustibles:
☐ Curtains ☐Spacing ☐Covered Openings ☐Drains/Tank Openings Sealed
Exposures
☐ Spark Arrestors ☐Wetting ☐Other:
Material of Construction - what material will be cut or welded? NA ☐
☐Galvanized Steel ☐Carbon Steel ☐ Stainless Steel
Respiratory
☐Coated/Painted Steel ☐ Aluminum ☐ Other:
Protection and
Precautions required for cutting/welding material noted above:
Ventilation
Ventilation: ☐ Source Capture ☐ Area Fan ☐ General Open Air ☐ Other:
Respirator: ☐ Air Purifying ☐ Respirator, Air Supplied ☐ Other:
Fire Watch duties ☐Closed / Non-Flame Hot Work. Fire Watch not required. NA ☐
required? ☐Open Flame Hot Work. Fire Watch is required.
Extinguisher(s) have been designated for Fire Watch duty: YES☐ NA ☐
Fire Extinguishers Type: ☐ABC ☐ CO2 ☐Water ☐ Other:
Extinguisher inspected, ready for service. YES☐
High Risk Hot Will hot work be performed on equipment in service, or hot tapping? YES☐ NA ☐
Work If yes, approval required by higher level manager.
Other PPE / Special Instructions:

APPROVAL & ACCEPTANCE

I agree the scope of work can be carried out provided all conditions specified on this permit and associated HA and PTW are met. Work
period may not exceed 16 hours without revalidation. Hot Work must begin within 30 min of initial gas testing, if required.
Hot Work Is Approved For The Following Duration (Time): Begin: End:

Permit Approver: Name: Signature: Time:

Additional SME: NA☐ Name: Signature: Time:

I understand & agree to permit conditions, and have verified that they have been met. I have communicated all conditions with Permit
User(s).
Person Managing
Name: Signature: Time:
Control of Work:
Actual Hot Work Start Time:
PERMIT REVALIDATION
Will the hot work permit be revalidated? YES ☐ NO☐
If yes, refer to the PTW revalidation section to document each revalidation.
WORK COMPLETED - PERMIT CLOSURE
Actual End Time:
Person Managing Name: Signature: Date:
Control of Work:

Permit Approver: Name: Signature: Date: Time:

Area within 50’ of hot work operations monitored for 30 minutes after work completed, found to be safe. Actual End Time
+ 30 Minutes:
Fire Watch: NA☐ Name: Signature: Date: