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Permit To Work No: Date: Project: Location: Contractor: Consultant: Employer Nature of Hot Work

This hot work permit document outlines the safety procedures and requirements for performing hot work at a specified location. It provides details such as the date, permit number, project name, contractor, location of work, and nature of the hot work. It also lists the potential ignition sources, hazards, required personal protective equipment, gas testing records, and approval signatures needed from the performing authority, approving authority and permit coordinator to authorize the work and close out the permit. Upon completion of the work, the permit must be properly closed out and logged.

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RaymondGomezBlanco
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20 views2 pages

Permit To Work No: Date: Project: Location: Contractor: Consultant: Employer Nature of Hot Work

This hot work permit document outlines the safety procedures and requirements for performing hot work at a specified location. It provides details such as the date, permit number, project name, contractor, location of work, and nature of the hot work. It also lists the potential ignition sources, hazards, required personal protective equipment, gas testing records, and approval signatures needed from the performing authority, approving authority and permit coordinator to authorize the work and close out the permit. Upon completion of the work, the permit must be properly closed out and logged.

Uploaded by

RaymondGomezBlanco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HOT WORK PERMIT

DATE:

PERMIT TO WORK NO:


PROJECT:

LOCATION:

CONTRACTOR:

CONSULTANT:

EMPLOYER
NATURE OF HOT
WORK:

IGNITION SOURCE:

electrical equip ment

tools

open fla me

v e hicle

e xtension leads

other

PARTICULAR HAZARDS & CONTROL MEASURES:

SPECIFIC PPE:

hearin g protection

safet y harness

dust m ask

hot w ork clothin g

rubber boots

g o g gles

other

face shield

glo ves _______

SPECIFIC
EQUIPMENT:

Fire blanket

Safet y barriers/signs

Fire E xtin guisher

Fire hose

Portable gas
detector

(t y pe)

che mical suit


other

GAS TEST RECORD:


Frequenc y of tests:

Continuous m o nitorin g : Yes/No

Date/Time
Tester
O2 %

(19.5 %

22.5)

LEL %

(% 10)

O ther
REVIEW AND AUTHORIZATION:
I, the appro vin g authorit y, ha ve inspected the w o rk area and hereb y con firm it is safe to perfor m this
task under the conditions of this per mit.
Na me:.. Signature.. Date..
...
I, the per mit coordinator, ha ve re vie w ed this per mit and supportin g doc.s and con firm that the y are in
co m pliance w ith the per mit procedure.
Na me:.. Signature.. Date..
...
I, the perfor min g authorit y, accept the conditions stipulated in this per mit and con firm that all control
m easures and isolations are in place.
Na me:.. Signature.. Date..
...

CLOSE OUT:
THE W O RK IS COMPLETE
THE W O RK IS INCOMPLETE A N D LEFT IN THE F OLLO WING CON DITION (STATE REASON):
Perfor min g authority: I declare that the w ork for w hich this per mit w as issued has been properl y
perfor med, and that the area has been left in a safe, clean, condition.
Na me:.. Signature.. Date..
...
A ppro vin g authority: I ha ve inspected the w ork area and declare that the w ork for w hich this per mit w as
issued has been properl y perfor med, and that the area has been left in a safe, clean,
Na me:.. Signature.. Date..
...
PT W coordinator: I declare that this per mit to w ork has been closed out as per per mit to w ork procedure
and been log ged into the per mit to w ork register under the docu ment control g roup (DCG )
Na me:.. Signature.. Date..
...
Hot Work Permit

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