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
                                                                              Page 1 of 2
 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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