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Hot Work Permit Form for Safety Compliance

This hot work permit document contains 6 sections to authorize and manage hot work such as welding, grinding, or other spark-producing activities. Section I describes the location, work, duration and responsible parties. Section II lists precautions to avoid fire and other hazards. Section III is for requesting the permit. Section IV is for issuing and authorizing the permit. Section V is for extending the permit duration. Section VI is for closing out the permit upon work completion.

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imranul haq
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583 views2 pages

Hot Work Permit Form for Safety Compliance

This hot work permit document contains 6 sections to authorize and manage hot work such as welding, grinding, or other spark-producing activities. Section I describes the location, work, duration and responsible parties. Section II lists precautions to avoid fire and other hazards. Section III is for requesting the permit. Section IV is for issuing and authorizing the permit. Section V is for extending the permit duration. Section VI is for closing out the permit upon work completion.

Uploaded by

imranul haq
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
  • Risk Assessment: Outlines precautions and risk assessment to mitigate hazards associated with hot work activities.
  • Task In-charge Responsibilities: Responsibilities specific to the task in-charge, including documentation and safety measures.
  • Hot Work Permit Details: This section includes metadata of the permit such as business unit, permit number, and dates.
  • Permit Extension and Handover: Provides sections for extending the permit validity and transitioning responsibilities.
  • Permit Closure: Describes the procedure for closing the permit after the completion of work, including final signatures.
  • Validity and Approval: Details the validity period of the permit along with necessary approvals and signatures required.

SECTION HSSE

STATUS CONTROLLED

HOT WORK PERMIT REFERENCE PPC/HSSE Permit 001

‫شركة التغليف الرئيسة‬ REVISION 0 DATE 11/04/2019


Premier Plastic Company SHEET 1

BUSINESS UNIT :
DATE
PERMIT FOR (Company) : PERMIT NO. :
APPLIED :

SECTION I:

Location of work: ______________________________________________________________________________


Description of work: ____________________________________________________________________________
Approx. duration of work: From(time) ____________ am/pm To(time) ______________ am/pm
Name of task in-charge: _________________________________ Phone No. : ____________________
Required documents: Method statement: Risk Assessment:

SECTION II (Precautions to avoid potential hazard):

1. Pre check has been done for the area; free from combustibles and area barricaded. Yes / No / NR
2. Portable fire extinguisher in place. Yes / No / NR
3. Fire watch provided. Yes / No / NR
4. Fire blanket being used. Yes / No / NR
5. Ventilation sufficient. Yes / No / NR
6. Protection provided for other workers and property. Yes / No / NR
7. Operator is trained and competent. Yes / No / NR
8. Operatives are in possession of the PPEs specified for the task. Yes / No / NR
9. Gas cylinders fitted with flash-back arrestors. Yes / No / NR
10. Gas cylinders are vertical and secured. Yes / No / NR
11. All power tools are in good working order. Yes / No / NR
*NR - Not Relevant

SECTION III (Permit requested by): Task In-charge

 Maintenance
 Production
 Others (Specify) ______________________________

I request for a permit for the above mentioned work at the location specified above. I have personally inspected the
work place to ensure that requirements needed as precautionary measures as mentioned above have been complied
with.
Name (Person Requesting): ____________________________ Signature: ______________ Time: _____________

PPC/HSSE/HTWP Form/004/1/Rev 0 Dated 11th April, 2019

SECTION HSSE
STATUS CONTROLLED
REFERENCE PPC/HSSE Permit 002
HOT WORK PERMIT
REVISION 0 DATE 11/04/2019
‫شركة التغليف الرئيسة‬
Premier Plastic Company SHEET 2

SECTION IV (Permit issued and authorized by):

Work shall be carried out (only) after complying with the requirements of section II and the following Signatures below.

This is valid up to (Time): ______________________________________ Date: __________________

HSSE Incharge: Name __________________________ Sign. _________________ Phone ______________

Plant Manager: Name __________________________ Sign. _______________ Phone ______________

SECTION V (Extension of Permit):

We approve the extension of the above work after personal inspection, conditions mentioned in Sec. II are ensured.

From: _____________________ hrs. To: ________________________ hrs.

Requester: Name _________________________________ Sign. ________________________ Time _____________


Issuer: Name _________________________________ Sign. ________________________ Time _____________
Authorizer: Name _________________________________ Sign. ________________________ Time _____________

SECTION VI (Closing of Permit):

The work is completed and the area has been cleaned.

Name (Person Requesting) _______________________________ Signature ________________________


(Name as in Section III)

Time ____________________ Date ____________________

To be returned to the HSSE Department after completion of work and duly closing.
Names of the persons involved in the task to be briefed by Supervisor and HSE Personnel:

PPC/HSSE/HTWP Form/004/1/Rev 0 Dated 11th April, 2019

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