Hot Work Permit

Permit no : Date:
Project :
Specific job Location :
Specific Job description:
Name of equipment (s) used: ……………………………………………………………………………………………………
Identification no. of equipment(s) used: …………………………………………………………………………………..
Contractor :
Fire
DESCRIPTION YES NO REMARKS

Safety precautions:

The technician has inspected the proposed precautions

taken to prevent fire
Electrical Isolations:

Electrical isolation required for equipment isolated

Electrical cables covered

General Precautions:

ABC Fire extinguishers provided & is in service

No Extinguisher has been removed from Fire point

Apart from above extinguisher, standby nearest

extinguisher is located at
Hot work Equipment carries Safety inspection tag

Area supervisor notified

Area under permit is barricaded

Precautions near area of work:

Nearby area swept clear of combustibles

No combustible, flammable liquids are near by

Is fire blanket provided?

Fire watcher:

Name of Fire watcher

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 He is trained in use of fire extinguisher. Record to this
effect is available
Additional preventive measure may be added if needed:(Use additional sheet if needed)

Declaration of initiator / Contractor:

a. All the above safety precautions have been put in place, based on Job safety analysis as per
method statement and verified by me on ground personally.
b. I shall ensure all the necessary precautions, till end of the work & I shall take full responsibility
in case of any deviations or lapses noticed on site.

Name & Signature of the technician:

A. Permit Initiation & Issue

Details Name Signature, Date & Time

I have checked the above points and found the conditions suitable to undertake the work.

Permit Initiator
(Contractor PM / Engineer)    
Checked & Confirmed By
(Contractor Safety Officer)    

Permit is granted & valid up to date ………………………………& time: from………………. to ………………………

Client    
B. Permit Closure:

The above-mentioned job has been completed satisfactorily. Date…………………………………. & Time ………………………………
this permit is closed.

(Contractor PM / Engineer/safety)    
Client    

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