COMPANY LOGO Hot work permit

Page 1 of 2 Work order no.

Description
activities/location

Place Issued by construction management Signature

Issued to Company Signature

Valid from Valid to Date Initials

Does the contractor have a contractor passport? Yes/No

Equipment Electricity
Power supply switched off and
Pressure free Safety switch
secured by:
Blocked in MCC fuses removed and labelled Name

Blinded/capped Voltage free proven

Flushed with Initials
Valves labelled

Workplace
Flammable substances removed
Gaps covered Radio active source secured
from area
Glass wool blanked at workplace Sprinkler system on pressure Scaffolding approved
Fire extinguisher type Area fenced off
Initials

Personal protection equipment which must be worn in addition to the compulsory equipment:
hard hat, safety shoes, safety goggles)
Rubber working gloves Ear protection
Rubber boots Radio telephone
Face masker/safety goggles Safety line/belt
Dust mask Acid/gas protection overalls
Escape mask Explosion test % LEL Vol. %
Emergency fresh air hood/compressed air Repeat of frequency explosion test

Personal instructions / special hazards

Different permit required Corrosive substances Risk of failing
Contractor passport Poisonous hazard
Forklift truck certificate Fire and/or explosion hazard

Statement of agreement
Permitting party Supervisor

Security guard Executing party

Client Project

Client’s project no. Construction site

rev. date Description/issued for signed checked seen

Office
COMPANY LOGO Hot work permit

Page 2 of 2 Work order no

Hot work permit, instructions for application

1. The hot work permit has to be applied to:
 all activities concerning fire and/or explosion hazards, such as welding, cutting, grinding, soldering, etc.
 activities in explosion free rooms/areas, which have a higher fire/explosion risk.

2. Activities in workplaces are exempt from the hot work permit.

3. The hot work permit is completed in duplicate by the department for which the work is done. After authorisation
and signing by the construction management, the executing party keeps the copy and the original is kept by the
construction management.

4. The executing party checks the measures taken and signs for agreement. He is responsible for a safe execution
of the work. (Correct tools, personal protection equipment, attention to the range of welding sparks and suchlike).

5. The hot work permit is issued in the name of the executing party and is not transferable. When the executing
party stops working, he will have to hand in the permit to the construction management.

6. The hot work permit is only valid on the day of issue.

7. At the beginning and ending of the work, the executing party reports to the construction management.

8. If the circumstances change, the activities need to be stopped immediately and a new permit has to be
requested.

9. In the event of an emergency, the activities are stopped immediately. A new hot work permit is required to
resume the work.

10. After its statement of agreement the construction management is responsible for releasing, keeping clear of and
securing the installation and its surroundings, before starting as well as during and after the work.

11. When in doubt, consult the SHE supervisor.

Take care! Welding equipment has to be taken to the workplace after finishing the daily activities
(pressure free).

12. After the work has finished the hot work permit has to be submitted to the construction management.