Hot Work Permit

IREO,SEC-58 GURGAON HARYANA

SAFE WORK PERMIT FORMS HOT WORK PERMIT (No overwriting no alteration permitted)

SC SAF FM-30

Hot Work Permit .To be filled by permit seeker Kindly issue a work permit for Hot Work Location: Nature of activity to be executed:

Date:

Time

from_____

To ___________

I confirm the following Safety Status for carrying out the above hot work. Descriptions Observation Descriptions (Yes/No/NA) ELECTRICAL ISOLATION OF WELD JOB IF REQUIRED EQUIPMENT ISOLATED WARNING SIGNS LOOKOUT SENTRY FIRE BLANKET TO BE USED WELDING SHIELD FOR WELDER FIRE PRECAUTION: AREA CLEAR OF COMBUSTIBLES HAZARD MARKERS AND LIGHTS REQUIRED BODY EARTH PROVIDED IN WELDING M/C WELDING APRON

Signature:

Observation (Yes/No/NA)

BARRIERS REQUIRED PORTABLE LIGHTING NO SMOKING OR NAKED FLAME SCAFFOLDING ETC. REQUIRED FIRST AID KIT FIRE EXTINGUISHER KEPT AT WORK PLACE REQUIRED PPE AVAILABLE WELD SHIELD, APRON,S BOOTS INSPECTION TAG PUT ON THE WELDING M/C WELDING LEAD WITH LUGS & FREE OF JOINTS OTHERS (IF ANY)

_____________________ Name:__________________Designation: ________________

Company Name:___________________Date:_______________Time:_____________________ ______________________________________________________________________________ To be filled by immediate superior of person applying for permit I have verified the Safety status and permission to above mentioned is recommended. Signature: ____________Name:_________________Designation:_____________________

Company Name:__________________Date:__________________Time:_____________________ ________________________________________________________________________________ To be issued by the tower incharge of Civil Contractor. Permission granted vide permit no:_________________Dated ________________Time:_________ Signed:__________________Name:___________________Designation___________________

Company Name:_________________Date:______________Designation:__________________ __________________________________________________________________________________ Disposal: I have completed the required work. Permit may be closed. Signature of permit seeker__________________Date: ___________ Time:____________________ __________________________________________________________________________________ Closure: The safety status has been verified and the permit is closed. Signature of permit issuer_________________Date:___________________Time:______________