Hot work permit

 

Section I (General details)

PERMIT NO

PROJECT

PERMIT

FOR

(Company)

Location of

Activity

Work

Date

Time From

Time To

Section II (Precautions to avoid Potential hazards):

1

Area cleaned from

Yes/No/NR

7

Operator  is

trained

and

Yes/No/NR

combustible materials

competent

2

Fire extinguisher is in

8

Operator

are

in

Yes/No/NR

possession

of

the

PPE

Yes/No/NR

place

specified for the job

Gas

cylinders

fitted

with

3

Fire watch provided

Yes/No/NR

9

flash

back

arrestors

and

Yes/No/NR

free from leakages

4

Fire blanket being used

Yes/No/NR

10

Gas

cylinders

are vertical

Yes/No/NR

and prevented from falling

5

Ventilation sufficient

Yes/No/NR

11

All  Power

Tools  are  in

Yes/No/NR

good working order

6

Protection provided for

other workers and

Yes/No/NR

property

Section III (Permit Requested by):

I request for a permit for the above mentioned work at the location specified above. I have personally

inspected the work place to ensure that requirements needed as precautionary measures as mentioned

above have been complied with.

Name (Permit Applicant )

Signature

Section IV : (Permit approval)

Approved/Not Approved

Comments :

Name (Person Approving)

Signature

Permit close out request (By the permit applicant)

I have inspected the work area after the completion of work and I certify that the area is cleaned and brought to

the normal condition.

Name (Permit Applicant )

Signature

Verified and closed

Name :

Signature

WP- Hot Work

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Annexure - 1: List of p

 

Date:                                                            Activity:

 

Area / Location:

 

Time :

 

Permit Holder Name

 

Contractor Name

 

 

SR	Name of Workmen/Staff	Trade	Contractor Name	Signature
No.

 

1

 

2

 

3

 

4

 

5

 

6

 

7

 

8

 

9

 

10

 

11

 

12

 

13

 

14

 

15

 

 

Note: No unauthorized person, other than listed above, shall be engaged in for this hazardous activity.

 

 

Name (Contractor Representative): …………………………………Signature: ………………………………

 

 

 

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