Rev No.

– 005
Rev Date- 01/04/2023

PERMIT TO WORK- HOT WORK

Permit No:
Section – I GENERAL DETAILS
Project Name
Activity/Type of work
Description of work

Area/Location
Date : Time From : AM/PM To : AM/PM (Max up to 06.30PM
only)
Permit Applicant Name
Contractor Name No. of Workers
Involved :
Job specific PPE required during
work
Section – II PRECAUTIONS TO AVOID POTENTIAL HAZARDS
PRIOR TO COMMENCEMENT Y N DURING EXECUTION Y N
Hazard Identification and assessment of risk attached
Appropriate Working Platform provided.
with permit
Welding machine electrical terminal insulation checked. Safety/Warning Signage in place.
Adequate earthing provided Adequate Ventilation available.
Remove Flammable materials, including accumulations
of dust, from the vicinity of the worksite ( area of Good condition of the welding cables.
…………m, possibly including adjacent area)
Appropriate Fire Extinguisher Provided. Adequate illumination available.
Flash Back arrestors provided for gas
Operatives trained in using fire extinguisher.
Cylinders.
Fire Blankets if required, Provided. Cylinders Kept in trolley and secured.
Fire Watch Person available. Regulators and gauge in good condition
No cracks in hoses of gas cutting/ welding
Area barricaded, signage provided.
set.
Appropriate PPE Provided. Isolation of Equipment required.
Section – III (Permit Requested by):
I request for a permit for the above mentioned work at the location specified above. I have personally inspected the
work place to ensure that requirements needed and precautionary measures as mentioned above have been
complied with.
Checked by Name Designation Signature
Contractor site In charge

Authorized by Issuing authority(MDL Name Designation Signature

L3 Area Manager / L2 )
Acknowledge by MDL EHS Name Designation Signature

Section – IV PERMIT CLOSURE

The above job is completed at, Time:…………………….. and ensure area is safe

Permittee (Name)…………………….………Signature:………………………..Date & Time:……………………..

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 Rev No. – 005
Rev Date- 01/04/2023

The above work is completed, permit closed & permit submitted to EHS.

Issuing authority (Name):…………………….Signature:………………………. Date & Time:………………….…

Tool Box Talk Attendance Register
TBT Topic -………………………………………………… TBT Duration - ……………………………….
Please tick ( ) below point
1. Safe use of ladder 2. Personal protection Equipment 3. Electrical Safety
4. Behavior Based Safety (BBS) 5. Fire prevention 6. Housekeeping 7.Hot work
8. Emergency Response 9. Mental Health 10. Health & Hygiene 11. Excavation
12. Material Storage & Stacking 13. Hazard identification 14. Safe use of Chemical (COSHH)
15. Manual Handling 16. Power & Hand tools 17. Falling hazard & Falling object
18. Working in confined space 19. Vehicle/ Equipment 20. Safe working platform
21. Work at height 22. Work in night 23. Covid-19 precaution
24. Waste Management 25. Lifting activity 26. Others ………………………………
I have attended the Tool Box Talk and have fully understood and commit to follow it at my work area to
make the workplace safer.
List of person attended Tool box talk and authorized for Hot work activity
SR Name of Workmen/Staff Designation Contractor Name Signature
No.

10

11

12

13

14

Note: No unauthorized person, other than listed above, shall be engaged for hot work activity
Name of Trainer:………………………………… Signature:…………………….
Name (Contractor Work In charge): …………………………………… Signature:…………………………………

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