Project Name /

No.
Project Manager:
Document No. NAI-HSE-015

Revision No.
GAS WELDING PERMIT
Date:

[The first revision shall be named as “0” followed by 1, 2, and 3 for the subsequent revisions. The revision number
shall be indicated on the header of the document i.e. [Project no.] – COMPANY- 0). The amendments shall be
described in the amendment record.]

This form is to be filled out in its entirety by the responsible person actually performing the "GAS
WELDING" and then brought to the Health, Safety and Environment Department (HS&E) for approval
prior to beginning the task.

Responsible Person: Date:

Work to be performed: Start Time:
Project site:
Work Area:
Is it possible to perform this work in the shop? Yes  No  Phone no. of Responsible Person:

Please place a check mark  if the following items have been completed
Flame producing equipment to be used has been inspected and found in good repair
Adequate access/escape route?
There are no combustible fibers, dusts, vapors, gases, or liquids in the area. If there is a possibility of a leak
developing in nearby piping, or equipment this area is to be continuously monitored.
Flammable materials removed within the working vicinity?
Are all employees trained and judged competent in the use of welding apparatus?
Surrounding floors have been swept clean and, if combustible, wet down.
Availability of portable fire extinguishers and trained personnel to use them.
All combustibles have been relocated 35 feet from the operation.

Is all welding apparatus (torches, regulators, pressure- reducing valves, acetylene generators, and manifolds)
purchased from reputable welding dealers who have indicated the equipment is suitable for the intended
purpose?
Responsible personnel have been assigned to provide a "Fire Watch" for dangerous sparks in the work area,
as well as on floors above and below while work is being performed.

Arrangements have been made to provide a "Fire Watch" to be stationed in every work area including floors
above and below, during and after the tasks have been conducted for at least 15 minutes after the work has
been completed.
Are oxygen and acetylene cylinders kept away from radiators and other sources of heat?

Inside buildings, are cylinders stored in well-protected, well-ventilated, dry locations

at least 20 feet from highly combustible material such as oil?
Are cylinders stored in designated spaces where they will not be knocked over,
damaged by passing or falling objects, or subjected to tampering by unauthorized people?
Do cylinders have the control valves?

Are stored oxygen cylinders separated from fuel-gas cylinders or combustible materials
(especially oil or grease) by at least 20 feet, or by a noncombustible barrier at least 5 feet
high with a fire-resistance rating of at least one-half hour?

NAI-HSE-015
 Project Name /
No.
Project Manager:
Document No. NAI-HSE-015

Revision No.
GAS WELDING PERMIT
Date:

Are cylinders, cylinder valves, couplings, regulators, hoses, and apparatus kept free
from oily and greasy substances?
Are employees required to handle oxygen cylinders with oil- and grease-free hands or gloves?
Is care taken to ensure cylinders are not dropped, struck, handled roughly, or
permitted to strike each other violently?
Are cylinders kept far enough away from the welding or cutting operation so that sparks,
hot slag, or flames will not reach them? Or, are fire-resistant shields provided?
Is flash-back protection provided by an approved device that will prevent flame
from passing into the fuel-gas system?
Are the fuel-gas hose and oxygen hose easily distinguished from each other and are all hoses inspected at the
beginning of each day?
Are union nuts and connections on regulators inspected before use to detect faulty seats
that may cause leakage of gas when the regulators are attached to the cylinder valves?
Are torches lighted by friction lighters or other approved devices?

Are defective torches removed from use?

Permit Closeout
Job Completed? Yes 􀀀 Signature of Responsible Person:
No 􀀀

I attest that the above precautions have been taken

Person Responsible for Performing Hot Work

Approved
HSE Department Date

NOTE: This permit expires 1 week after the designated "start time." If work is to continue another permit must be
issued.

NAI-HSE-015