HOT WORK PERMIT (SUPPLEMENTARY PERMIT)

Any Alarm, Alert, weather conditions or other Emergency Suspends / Cancels this permit. To Restart Contact Permit Issuance Authority.
NOT valid unless accompanied by a PTW Hot Work PERMIT No:

PLANT/Uni
VALID FROM (Date/Time): VALID TO:
t
Equipment No:
Isolation
Functional (Group or
MAIN PTW No. WO No Certificate
Location: Individual KKS)
No:
Description of work
(Engica shall automatically take work description from JHA and Provision to put more details )

1. Precautions / Checklist for Work Execution by Issuing Authority / Appointed Person YES NO NA
Has the equipment been properly de-energized and de-pressurized as per isolation certificate?
If the work involves Confined Space Entry, has Confined Space Permit been issued? If YES, is continuous air monitoring established?
Can all hot work be removed to a less hazardous area?
Has the gas test done?
Are expolivity limits outside LEL and HEL ranges? Explosivity reading LEL: _________________ ; HEL:_________________
Is adjacent area safe for sparks?
Is fire extinguisher / steam lance / fire hose placed close by?
Is the welding or heating equipment in safe working order & is a safe place?
Is the fire equipment under impairment in the area where the work is going on?
Is relevant MSDS available for the chemicals/material which may be encountered during the job?
Has the personnel in the Units/Area affected by this work been notified?
Fire Watcher Name: _________________________

2. ERSONAL PROTECTIVE EQUIPMENT FROM JHA

State Special Remarks/Requirements :
Yes No NA Yes No NA
Face Shield Rubber Shoes
Welding Hood with safety Sheet Rubber Gloves
Lather Gloves Full Face Mask
Chemical Suit/Apron Fire Blanket
3. ISSUANCE & ACCEPTANCE:
Permit Receiver :I hereby declare that above information are accurate and the controle measures fixed on the final JHA will be followed
Authorized Issuer/ Appointed Person, Name: Signature Date Time Operator/Authorized Person Signature/Date/Time
/Isolation Authority Name:

Permit Issuer : I hereby declare that I am satisfied with completion requirements

Name Saginature Date Time

HSE Manager : I hereby declare that I am checked the mesures at site and I have declare satisfied with completion requirements
Authorized Accepter/ Maintenance/ Signature Date Time
Responsible Person, Name:

5. PERMIT CLOSURE
Permit Receiver : I declare that All work associated with this permit is completed, & House keeping done and this permit is closed
Authorized Accepter/ Maintenance/ Signature Date Time
Responsible Person, Name:

Permit Issuer : All work associated with this permit is completed, & House keeping done and this permit is closed
Permit Acceptor /Responsible Person Name: Signature Date Time:

HSE Manager : All work associated with this permit is completed, & House keeping done and this permit is closed
Permit Issuer/Responsible Person Name: Signature Date Time:

Permit Acceptor /Responsible Person Name: Signature Date Time:

Permit Issuing Authority/Appointed Person): I hereby declare that I am satisfied with completion requirements & close / cancel this permit. Communication performed with CCR and
Permit Issuer/Responsible Person Name: Signatire Date Time:

NC/PTW/SP-001/FM-031 Rev. 00 Date 28 Aug 2017 1