HOT WORK PERMIT

DATE & TIME: PERMIT No: CONTINUED PTW No:

WORK DISCRIPTION
MAIN DISCRIPTION OF WORK

WORK IS COMPLETE WORK IS INCOMPLETE AREA IS SAFE

 PERMIT HOLDER NAME
WORK LOCATION
PERMIT VALIDITY
(maximum of 12hrs)
Permit valid from: Permit valid to:
PRECAUTIONS AND PROTECTIVE EQUIPMENTS
(Do not start work until safety precaution arranged)
1. Gas test 11. Extra ventilation
2. Trained fire watcher required 12. Safety tag/sign/lock
3. Fire blanket 13. Drain covers
4. Fire extinguisher 14. Electrical Isolation(LOTO)
5. Equipment to be protected from hot metal and 15. Adequate Lighting
spark 16. Escape Route checked
6. Removal of flammable materials from hot work 17. Road Closure comply
area 18. Extra Ventilation
7. Barricade and Sign posted 19. Process Isolation
8. Stand By Person Required 20. Not applicable
9. Grounding/ Earthing
10. Scaffolding
HAZARD CONSIDARATION GAS TESTING RESULTS
1. Fire hazard 7. Noise COMBUSTABLE %LEL
OXYGEN %
2. Hot surface 8. Radiation
H2S – ppm
3. Dust/Fibers 9. High Pressure CO – ppm
4. Slip/Trip 10. Working at height OTHER HYDROCARON %
5. Falling Object 11. Oxygen deficency (Limits : combustible% of LEL, Oxygen – 19.5 to
6. Chem/Tox/Corr/H2S 12. Static Electricity 23% by Vol, H2S 5ppm, CO – 25ppm, NH3 -
CERTIFICATES & OTHER DOCUMENTS 25ppm, SO2 – 2ppm, Chlorine – 0.5ppm, Benzene
JSA/RISK ASSESSMENT HSE Plan – 0.1ppm.) All Safe Testing
Confined Space Entry Certificate Requirement Every___ Hrs.
Excavation Certificate
Others:_____________________________________ Date & Time :
Name :

APPROVALS
PERMIT ISSUER PERMIT HOLDER
Name:
Sign :
Date :
Time :

WORK IS COMPLETE WORK IS INCOMPLETE AREA IS SAFE

 CLOSURE/ CANCELLATION

WORK IS COMPLETE WORK IS INCOMPLETE AREA IS SAFE