Permit to Work (PTW)– Hot Work

Permit No. Date

Project Contractor
Location
Job Description

Time Start……………………………. End………………………….

Name of equipment
(s) used:
Identification no. of
equipment(s) used:
A. Check Points:
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?

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 Permit to Work (PTW)– Hot Work
Fire watcher:

Name of Fire watcher

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)

B. Permit Initiation & Issue

Declaration of Contractor:
a. All the above safety precautions have been put in place based on Job safety analysis provided
by my organization and verified by me on ground personally.
b. I shall ensure all the necessary precautions are in place till end of the work & I shall take full
responsibility in case of any deviations or lapses noticed on site.
Permit Initiator
(Contractor PM / Engineer)
Checked & Confirmed By
(Contractor Safety Officer)
Comments by PM/CM The contractor is expected to undertake work at site as per their
Safety Precautions and Job Safety Analysis. In case of any Non-
Conformance (NC) to the above noticed by PM/CM/ Consultant/Client
during site rounds, necessary actions as per Contract/Statutory
conditions shall be recommended to Client.

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

Details Name Signature, Date & Time

The work has been completed and can be closed
Permit Initiator
(Contractor PM / Engineer)
Checked & Confirmed By
(Contractor Safety Officer)
Comments by Contractor if
any

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