HOT WORK PERMIT

Permit No. 001

This Permit is only valid for the shift in which it was issued and authorised, it may not be transferred between shifts.

PERMIT PREPARATION THIS PERMIT IS EFFECTIVE

Project Name: SM UDANETA CENTRAL 3 rd
FLOOR Location:  Barangay Nancayasan, Urdaneta City,
MALL EXPANSION Pangasinan, 2428 Urdaneta, Philippines 
PREPARED BY.: Safety Department Date and Time:
Work Description / Activity

NOTE 1 NOTE 2 NOTE 3

Hot Work Permits shall only be issued This Permit shall not be altered after it has been authorised. If a Recipients of Hot Work Permits shall fully understand their
by an authorised person change in the work area means the information contained on responsibilities while working under the control of a Hot Work
this authorised Permit no longer ensures a safe work place, the Permit. Each person working under the control of the Permit has a
Permit shall be cancelled and a replacement Permit issued. Duty of Care to abide by the instructions contained herein.

1. LOCATION / AREA OF WORK: 2. TYPE OF HOT WORK/S (Tick Required)

.........………………………………………………..….………………………........................................ Grinding Welding
.........................…………………………………………………………...
……………….................................... Oxy-Acetylene Cutting Lancing

5. DESCRIPTION OF HOT WORKS.

NOTE – If work to be done is non-routine prepare a TAKE 5 to determine work process and controls.
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6. SAFETY INSTRUCTIONS (To be completed by person authorised to issue Hot Work Permits)
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7. EQUIPMENT TO BE USED (Tick Required)
Breathing Apparatus Fire Extinguisher (If ticked – list type) Powder type
Hot Work PPE Safety Harness and Fall Arrestor
Standard PPE Ventilation
Hearing Protection Welding Flash Barrier/s
Fire Blanket/s Access Prevention Barrier/s
Fire Hydrant and Hoses Signage
Fire Truck Communication Equipment

8. TASKS TO BE PERFORMED BEFORE COMMENCEMENT OF HOT WORKS (Tick Required)

JSA created/Take 5 Equipment Purged

Review SOP Other Applicable Permits Completed and Authorised
Work Area Barricaded Flammable Fixed Objects Protected
Signage Installed Mechanical Isolation
Flammable Substances / Material Removed Electrical Isolation
Fire Fighting Equipment At Work Site Forced Ventilation
Atmospheric Monitoring Verbal Notification Of All Personnel In The Surrounding Area
Equipment Drained Fire Watch / Spotter Positioned At A Good vantage point.

POST WORK SPOTTER NAME: - AREA TO BE OBSERVED FOR 30 Min AFTER TASK COMPLETED.

AUTHORIZATION BEFORE WORK STARTS

9. PERMIT AUTHORISATION
Location of Hot Work has been examined, necessary safety precautions (as listed) have
been taken and permission is granted for Hot Work to commence
Name: ________________________________________ (Permit Issuer)
Signature: …………………………………………………...............................Date: ….…./…..…/…….…
10. PERMIT ACCEPTANCE (Permit Receiver)
I have read and understood all of the conditions of this Permit and undertake the
responsibility to inform all personnel working under the authority of this Permit of all
information contained herein:
Name:_____________________________ Signature:............................................…
NOTE! If conditions on the job site change, the permit issuer shall be notified
immediately.

CANCELLATION OF WORK PERMIT AFTER WORK COMPLETED

11. PERMIT CANCELLATION (Permit Reciever)

Name: …………………………………..……........................ Signature: ……………………………..………............................................ Dept.: …………………………..………….. Date: ………../…….…. /…………….

12. PERMIT CANCELLATION (Permit Issuer)

Name: …………………………………..……........................ Signature: ……………………………..………............................................ Dept.: …………………………..………….. Date: ………../…….…. /…………….

*Uncontrolled* Printed 9/12/2022 3:55 AM FIRI-HSE-/00/01/10/20

*Uncontrolled* Printed 9/12/2022 3:55 AM FIRI-HSE-/00/01/10/20