WORK PERMIT – HOT WORK

Date: Ref. #:

HOT WORK
Permit No. 2024
Year Serial number

1. SPECIFICATION OF WORK (by performing authority) 6. SITE GAS TESTS (testing device must have valid calibration certificate)
Project:
Test for flammable Others Retest every Hrs
Vessel/Workplace: Location:
Free from Free from
Task: Time Oxygen content
flammable gas other toxic gas

Weather condition: Wind: Knt Sea state Ft.

Work specification and drawings attached? Yes No

Equipment to be used:
Electric Pressurized Air Hand tools
Floating pontoon Cutting tourch Welding equipment
Name: Designation:
Rotating M/C Others:
Anticipated
commence:
Hrs Date / / Complete: Hrs Date: / / / /
Signature Date:

Task requested by: Designation:

7. ISSUE
Date: Signature:
Area Authority:
2. HAZARDS IDENTIFIED BY AREA AUTHORITIES
I have personally checked the condition of the site. The necessary required action has been completed.
Danger From:
The work may proceed. All necessary precautions as indicated have been taken or shall be taken during
Liquid/gas under pressure Naked flames/arcs Danger of falling in sea the execution of the job.
Tripping hazard Flying particles/sparks Excavations
Name: Designation:
Corrosive materials Radio active material Confined space
Flammable materials Electricity Pyrophoric Scale
Hot surface Moving machinery Sea state (vessel rolling/pting) Signed: Date: / / Time Hrs.

Lifting operation Static current (Sparks from rotating moving machinery)

Performing Authority:
Others:
I have read and understood the above conditions and precautions and I declare that I accept responsibility
for carrying out the work specified on this permit, that no attempt will be made by myself or by the men
under my control to carry out any other work and that I will notify the Area Authority upon completion /
3. PRECAUTIONS TO BE TAKEN BY AREA AUTHORITIES suspension of this work.
Name: Designation:
Thorough ventilation Provid suitable access and egress
Consider adjacent work Area free of flammable / toxic materials
Isolation of area Drains/sewers etc. within 15m of worksite sealed Signed: Date: / / Time Hrs.
Flushing with water Depressuruized
Inert gas purged Flash back arrestors 8. COMPLETION / CANCELLATION
Adequate supervision appointed
Others: Performing Authority:
I declare that the work for which this permit was issued has been properly performed, that all men have
been withdrawn, and that the equipment, plant and electrical apparatus affected by the work have been
Fire and Gas Detection inhibits: Zone Flame H2S Heat Gas left in a safe, clean condition.
Joint site inspection required prior to commencement?: Yes No
Affected area authorities consulted?: Yes The work is COMPLETE
No (if yes, specify) The work is INCOMPLETE, abandoned / postponed due to:

4. PRECAUTION TO BE TAKEN BY PERFORMING AUTHORITY

Standards / special procedures for this activity are identified and followed Name: Designation:
Continous Gas monitoring Adequate ilumination
Firewatcher present Fire resistant blanket shield erected
Fire hose / Reel run out Proper housekeeping of work area Signed: Date: / / Time Hrs.
Tool box meeting Secure loose material / equip.
Equipment involved shall complies with required std. Area Authority:
Equip. to be turned off and secured and secured when left unattended
I have inspected the equipment / work area and I declare that the work for which this permit was issued
Welding / burning equip. to be checked before starting. Separate earth lead to work piece
has been properly performed, that all equipment have been removed, and that the equipment, plant and
Standby personnel with mode of communication available
electrical apparatus affected by the work have been left in a safe, clean, condition.
Fire extinguisher (specify type):
The work is COMPLETE
Others:
The work is INCOMPLETE and normal operations may be resumed subject to:
5. PROTECTIVE CLOTHING & SAFETY EQUIP. REQUIRED
Standard Coverall Safety Helmet Safety boot
Welding suite/coverall Welding shield Welding boot Name: Designation:
Welding apron Full face shield Welding Gloves
Hearing protection Dust mask Gloves _________________
Walki talki BA set Inertia reel
Life Line Work vest Safety harness Signed: Date: / / Time Hrs.
Others:

PERMIT EXTENSION SITE GAS TEST REAVALIDATION SIGNATURES

From To Free from Free from Oxygen Area Authority Performing Authority
Date Time Date Time Flam. Gas Toxic gas content Name Signature Name Signature
/ / Hrs. / / Hrs.
/ / Hrs. / / Hrs.
/ / Hrs. / / Hrs.
/ / Hrs. / / Hrs.
/ / Hrs. / / Hrs.
/ / Hrs. / / Hrs.
Note: New Permit must be issued for any change in condition or cancellation Distribution: Original: Worksite; Blue: Permit Authorizer; Pink: HSED

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