Hot Work Permit Request Form

Permit issue timing 3.00 PM TO 5.30 PM

From, HOT WORK Permit No:-_________Date:-_____/______/_______

Name of Contractor:
RE : Issue of HOT WORK PERMIT.

Area:- (__________________
Location:- _______________________
Floor:- __________________________
Zone:- __________________________

Description of Work:-(Welding / Gas Cutting / Grinding / Brazing) ___________________

Date of Work:- ______/______/ 2017
Time of Work:- From______ _am to _______pm
Total No of Work Hours:- _______Hours

The following mandatory equipment as per the Requirement of the hot work is provided at the site. We assure that NO LPG - gas
cylinder will be used for the hot work.

MR-1
Sr No ITEM YES / NO REMARKS
1 Fire Extinguishers with expiry date of not less than 6 months from
work date
2 Sand Bucket / Water Bucket

3 Power will be taken from temporary power supply board.

4 Two welding cables will be used – one for welding electrode & the
other for connecting the job directly to the welding machine terminal.
5 Welding machine Earthed

6 Safety Shoes, Asbestos Hand gloves, Eye Protection goggles/ Visor

We confirm that the site around the location of the Hot Work is free from the following
MR-2
SL.NO ITEM YES / NO REMARKS
1 Combustible & Hazardous Materials
2 The Area is free from debris and garbage.
In addition we hereby undertake to follow the rules governing the Hot Work
Permit permission as mentioned below: -
1) This hot work permit is strictly valid only for the time permitted and
no extension of the same will have been deemed to be given unless obtained in writing.
2) The work permitted in this hot work permit will be stopped immediately, in case of any violation of conditions is noticed and
the equipment will be confiscated.
Thanking You
Yours truly,
Name ____________________________ Seal of the Company:
Sign ____________________________
Date _______/_______/ 2017
*CALL Safety Officer BEFORE START THE WORK, MO. 7219810686
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FOR OFFICE USE ONLY

Projects Recommendation
Kindly allow the Hot Works to be carried out by ___________________________________in the above mentioned premises.

Name Of Recommending Projects Authority: - ________________________________________

Sign:- _________________
Date ______/______/2017
 Hot Work Permit
Location:

Nature of Work:

HOT WORK Permit No: -_________Date:-______/______/_______

OPERATIONS APPROVAL FOR THE HOT WORK PERMIT

The site of the proposed work area has been Checked by all of the undersigned and that the Mandatory equipment and requirement as per
MR-1 & 2 in the application for Hot Work Permit have been complied with and are in place.

SL.NO ITEM YES / NO REMARKS

1 Adequate multi-purpose fire extinguishers readily available.
2 Adequate Sand Bucket / Water Bucket available
3 Power will be taken from temporary power supply board.
4 Two welding cables will be used – one for welding electrode& the
other for connecting the job directly to the welding machine
terminal.
5 Welding machine Earthed
6 Safety Shoes, Asbestos Hand gloves, Eye Protection goggles/ Visor
7 Nearest Hydrant identified and ready.
8 Painting and Hot work is not being carried out at the same time
9 Safety signs displayed in bold (DANGER : HOT WORK in Progress)
10 A guard/fire watch is provided during the complete work is in
progress.

The site around the location of the Hot work is free from
SL.NO ITEM YES / NO REMARKS
1 Combustible & Hazardous Materials
2 The Area is free from debris and garbage.

The following Safety Officer has been deputed exclusively Oversee the Works as mentioned in the above Hot Work Permit.
Safety Member Name: - ___________________________________________________

1. The Hot Work Site has been visited by me on ______/______/_______ at _______am/pm

2. Hot Work Commenced on _______/_______/______ _at _________am/pm
3. Hot Work Ended on ______/______/_______ at ________am/pm.
4. The Hot Work Site has been re-visited by me 30minutes after the end of the Hot Work on ______/______/_______ _at
________am/pm. Nothing untoward has been observed at the Hot Work Site.

Sir No Name & Designation Sign Date

1 Safety Officer

2
Chief Engineer