Permit No.
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HOT WORK PERMIT
Department : ………………………………………….………… Location : …..………………………………….……………………………
Equipment TAG No : ………………………………..………..... Equipment Name : ………….………………………….…………………
Nature of Work :……………………………………….………………………………………………………………….…….……….………..
Permit Requested By (User) Permit Issued By (CCR) Isolation Done By (If Req.) (E&I)
Name : …………………………….…..….. Name : ……..….………………………… Name : ……..………..………….………
Dept : ……………….………………..……. Dept : ………..…….…………………..... Dept : ……..………..…………….……..
Date : ………….…….……………..……… Date: …………..…….…………………… Date : ……..………..………..…….……
Time : ………………….…………………… Time : ………..……....…………………… Time : ……..………...………….….……
Signature : …………….…………..……… Signature : ……..…….………………….. Signature : ……..……...………………..
Action Taken By (E&I) Department for equipment power supply Isolation:
Equipment TAG No : ………………………………………….. Equipment Name : …………….……………………………………………
Panel Name : …………….……………………………………. Feeder No : …………………….……………………………..…………….
LOTO Permit No. : …………………………………..………… Lock & Key No. :………………………..………..………………………….
HOT WORK PERMIT CHECK POINTS
PPE’S Used: - Safety Helmet, Safety Goggles, Face shield, Nose Mask, Ear plug / Ear Muff, Hand Gloves, Safety Belt, Safety Shoes
S. NO. CHECK POINTS YES NO NA
1 Area Clean & Safe to work
2 Trained welder doing the job
3 Proper means of access & exits with Proper Illumination
4 Combustible material removed within 35 feet
5 Vessels and pipes been drained/degassed, cleaned and secured with water or inert gas
6 Contents of vessels and pipes been checked
7 Spark Isolated
8 Fire Fighting Equipment (Fire Extinguishers, Sand Bucket, Fire Blanket, Fire Hose etc.)
9 Welding set earthed
10 Gas cutting set in good condition & LPG Cylinder properly covered
11 Flash back arrester fitted to oxy acetylene hoses.
12 Ensure Barricading to be done
13 Ensure Stand-by Person to be available
Site Checked by HSEF/Authorised Person:
Name:-……………………………….……….Sign:-……………………..…… Date:-………….…………… Time:-………………………
Remarks: ………………………………………….………………………………………………………………………………….…………..
Note – Monitoring the area for next 1 Hrs. after finishing the Hot work
Restoration Requested By (User) Restoration Confirm By (CCR) Restoration Done By (If Req.) (E&I)
Name : …………………………….…..….. Name : ……..….………………………… Name : ……..………..………….………
Dept : ……………….………………..……. Dept : ………..…….…………………..... Dept : ……..………..…………….……..
Date : ………….…….……………..……… Date: …………..…….…………………… Date : ……..………..………..…….……
Time : ………………….…………………… Time : ………..……....…………………… Time : ……..………...………….….……
Signature : …………….…………..…….… Signature : ……..…….………………….. Signature : ……..……...………………..
