BTPL Format No : SHE 51 / R01 / 05.11.

2017

BTPL WORK PERMIT

( Hot Work Permit Overhead Work Permit M/c shifting Other Work Permit )
BEFORE INITIATING WORK, ENSURE THERE IS A SAFER WAY
o Hot Work Permit is required for any temporary operation involving open flames or producing heat and/or sparks. This includes,
but is not limited to: Brazing, Cutting, Grinding, And Soldering, Thawing Pipe, Torch Applied Roofing, and Welding.
o Overhead Work Permit is required for any temporary operation on Roof / Walls.
o Other Works that requires Permit includes M/c shifting using crane Machine maintenance by external agency & supplier re-work.
REQUIRED PRECAUTIONS CHECKLIST
Requested by: Date : Hot Work Permit
Department : Available extinguishers are in service / operable.
Pressure gauges, Protective valve cap, Hose are in good
Location :
condition
Flash back arrestor has been provided
Description of Activity: Cylinder secured by chain to the trolley with upright
position
ON / OFF knob, Regulator with indicator, Welding Lugs is
provided
No.of. Employees involved: No damage cables connected for Hot work
Double earthing has been provided to m/c
PPE'S Required: Shield/Eye Goggles/Leather Gloves/Cotton
Gloves/ Safety Helmet, shoe etc.
ELCB connected with industrial socket connected with
power.
Requirements within 10 m (35 ft.) of work
Flammable liquids, dust, lint and oily deposits removed.
Explosive atmosphere in area eliminated.
Hot Work being Done By: Floors swept clean, wet down
EMPLOYEE
CONTRACTOR: Fire watch/hot work area monitoring
(if combustible materials within a 35-foot radius of hot work
Purchase Order Ref. : cannot be removed / deemed necessary by the Permit
Remarks: The activities are performed as per the Authorizing Individual)
check list and satisfactory. Fire watch will be provided during and for 30 minutes after
work
Fire watch is supplied with suitable extinguishers.
Fire watch is trained in use of this equipment
Other precautions taken
Ample ventilation to remove smoke/vapor from work area.
Other personal protective equipment like Welding Goggles
Signature Signature / Safety Shoes availability & usage is ensured by the
(SUPERVISOR) (Dept.Head) Supervisor.
Overhead Work Permit
PERMIT DATE TIME Appropriate Safety Belts available for Working Personnel.
A.M. Safety Belts are in proper condition & usage is ensured by
EXPIRES P.M.
the Supervisor.
Clearance from Electrical Department Appropriate Ladder / scaffold used
Risk assessment to be conducted
M/c shifting:
Signature Lifting tools and tackles are in good condition & authroised
by third party certificate
Risk assessment to be conducted
Wire rope and slings free from tolerable damage
Operated with competent license holder

Portable Equipment:
Wheel guard available & (covering 3/4th area)
Proper equipment with proper wiring with ELCB should be
used for portable equipment
Signature Signature
(FACTORY MANAGER) (SAFETY MANAGER) Other Work Permit
Other personal protective equipment like Goggles
Whether Risk Assessment (RA) attached Yes No / Safety Shoes availability & usage is ensured by the
Whether any appropriate checklist attached Yes No Supervisor.