PERMIT TO WORK
Hot Work Cold Work Work At Height Electrical Confined Space Entry Excavation
1 Nature Of Work
2 Section / Area : Equipment / Machinery : Issued to :
Description of Work : :
Duration of Work : Start time : Date: Finish time: Date:
4
Tools/Tackels to be used (To be filled by receiver) Tick mark appropriate option
1. Gas Cutting - Gas Torch ( ) Gas Cylinder ( ) 8. Sand / shot blasting - Air compressor ( ) Electric device ( )
2. Welding / Brazing / Soldering - DG Set ( ) Cables ( ) Electric Machine ( ) Earthing
9. Excavation - Electric ( ) Pneumatic ( ) Manual ( ) JCB ( )
( ) Argon ( )
Others -
3. Drilling / Saw Cutting / Grinding - Electric Machine ( ) Manual ( )
5
4. Scaffolding - Metal ( ) Bamboo ( ) Rope ( ) Ladder / Cradels ( ) Crane ( ) Ladder ( )
5. Grinding - Electrical ( ) Manual ( )
6. Painting - Air Compressor ( ) Spray Gun ( )
7. Cleaning / Washing - Hydro Jet ( ) Solvent ( ) Power tools ( ) Mechanical tools ( )
Manual ( )
Safety Precautions required (To be filled by issuer) Tick mark appropriate option
1. Equipment / Work area inspected Yes / No 15. Proper means of access and exit provided Yes / No
2. Surrounding area checked, cleaned and covered Yes / No 16. Stand by personnel for supervision provided Yes / No
3. Sewers, Manholes, Hot surfaces etc nearby are covered Yes / No 17. Checked for Oil and Gas trapped behind the thin lining in the equipment Yes / No
4. Considered hazard from other operations and concerned persons alerted Yes / No 18. Shield provided against spark Yes / No
5. Equipment - Blinded / Disconnected / Isolated / Closed / Wedged Open Yes / No 19. Portable equipment and nozzles are properly grounded Yes / No
6. Equipment properly drained and depressurized Yes / No 20. Attendant at manhole provided for entry into confined space Yes / No
6 7. Equipment properly Steamed / Purged Yes / No 21. Adequate means of communication provided to standby person Yes / No
8. Equipment properly water flushed Yes / No 22. Trained attendant provided with rescue equipment / SCBA Yes / No
9. Free access for approach of fire tenders has been maintained Yes / No 23. Space adequately cooled for safe entry of person Yes / No
10. Provision of Safe Access / Platform / Working Arrangement at Height for carrying out 24. Continuous Inert gas flow arranged Yes / No
the job Yes / No
25. Portable electrical equipments properly earthed and provided with ELCB switches Yes / No
11. Equipment electrically isolated and tagged Yes / No 26. Informed Fire fighting squad about the activity Yes / No
12. Proper Illumination and Ventillation provided Yes / No 27. Gas Cylinders are kept outside the confined space Yes / No
13. Running Water Hose / Fire Extinguisher provided Yes / No 28. Checked spark arrestors on mobile equipments / vehicles Yes / No
14. Area cordoned off and Precautionary Tags / Boards provided Yes / No 29. Permit taken for Work at Height Yes / No
Gas / Vapour Test (Certification by the authorised Gas Tester)
Value Time Value Time Value Time Value Time Value Time Value Time Value Time
7 % LEL
% O2
Signature & initial of
Gas Tester
PPE's to be used (To be filled by receiver) Tick mark appropriate option
Safety Safety Hand Safety Double Lanyard Safety Others
8 Ear Muff Dust Mask Boiler Suit Face Shield Respirator SCBA Life Line
Helmet Shoes Gloves Goggles Harness
Permit Issuer Permit Receiver Electrical Clearence
I understood the work and its method of working to ensure that
The Area / Tank / Equipment is safe for Work/Vessel Entry/
it is carried out safely.No work will be carried out other than the Interity of electrical equipments checked and confirmed
Hot work. Inspected & certified
work authorised by this permit
9
Name Signature Date Time Name Signature Date Time Name Signature Date Time
Extension of Work Permit (All above precautions & preparations to be checked & confirmed before extension)
Time Signature with Initials
Date LEL Concentrations O2 %
From To Issuer Receiver
10
Completion of Work & closing of permit ( Job completed / Incomplete) Sign Date Time
The above stated work is completed. Manpower deployed is removed and work site area cleaned
11
Permit to Work accepted back. Electrical connections restored. Area checked for proper housekeeping
Page 1 of 2
Vessel Entry Details
Permit No Date
Sr.No Name Sign LEL % O2% In Out
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
NOTE :
1. Permit should be renewed in every shift and not beyond ONE CALENDER DAY
2. Permit stands cancelled immediately if any changes in work condition arises and should be renewed thereafter when work to be started
3. In case of gas or liquid releases or any unsafe condition, stop the work safely and immediately inform Operations Department.
4. Permit must be signed by authorised persons only.
5. In case of Emergency, stop all work in safe manner. Close the gas cylinders,isolate pertinent electric supply. .
6. Process equipments and Electrical isolation register to be updated after removing the isolations and tags.
7. Return earthing to be connected as close as possible and only to the equipment being welded.
8. Before issuing this permit the person signing should inspect the site and satisfy himself for condition and precautions fit for the job.
9. Till the time work is completed (start to complete) issuer / receiver shall be present all the time at the premises (Not be off work)
10. Monitor LEL , O2 and Gas concentration at regular intervals.
11. No Hot Work be allowed unless gas test confirms flammable concentration below 10 % LEL
12. For vessel entry, the atmosphere can be considered fit to breath if the O2 content is 20% & above and Toxic gas Concentration is less than 50 % of maximum limit of 8 hours exposure.
Page 2 of 2
