AL THAIL GROUP OF COMPANIES

HOT WORK PERMIT

DATE & TIME: PERMIT No: CONTINUED PTW No:

WORK DISCRIPTION

MAIN DISCRIPTION OF WORK

PERMIT HOLDER NAME
WORK LOCATION
PERMIT VALIDITY
Permit valid from: Permit valid to:
PRECAUTIONS AND PROTECTIVE EQUIPMENTS
(Do not start work until safety precaution arranged)
1. Gas test 11. Extra ventilation
2. Trained fire watcher required 12. Safety tag/sign/lock
3. Fire blanket 13. Drain covers
4. Fire extinguisher 14. Electrical Isolation(LOTO)
5. Equipment to be protected from hot metal 15. Adequate Lighting
and spark 16. Escape Route checked
6. Removal of flammable materials from hot 17. Road Closure comply
Work area 18. Extra Ventilation
7. Barricade and Sign posted 19. Process Isolation
8. Stand By Person Required 20. Not applicable
9. Grounding/ Earthing 21. H2S Monitor
10. Scaffolding 22. Radio
PERSONAL PROTACTIVE EQUIPMENTS
Safety Shoes Coverall Goggles Face Shield Hearing Protection
Safety Harness Hand Gloves Breathing Apparatus
Full/Partial Chemical Suit Dust mask Life Jacket Escape BA set
Other if any :
HAZARD CONSIDARATION GAS TESTING RESULTS
1. Fire hazard 7. Noise COMBUSTABLE %LEL
2. Hot surface 8. Radiation OXYGEN %
3. Dust/Fibers 9. High Pressure H2S – ppm
4. Slip/Trip 10. Working at height CO – ppm
5. Falling Object 11. Oxygen deficency OTHER HYDROCARON %
6. Chem/Tox/Corr/H2S 12. Static Electricity
(Limits : combustible% of LEL, Oxygen – 19.5 to
23% by Vol, H2S 5ppm, CO – 25ppm, NH3 -
CERTIFICATES & OTHER DOCUMENTS 25ppm, SO2 – 2ppm, Chlorine – 0.5ppm, Benzene
JSA/RISK ASSESSMENT HSE Plan – 0.1ppm.) ALL SAFE
Confined Space Entry Certificate TRIC Testing Requirement Every___ Hrs.
Excavation Certificate Equipment Checklist Date & Time :
Others:_____________________________________ Name: Signature:
 AL THAIL GROUP OF COMPANIES

PERMIT HOLDER DECLARATION

1. I HAVE READ THIS PERMIT TO WORK & ASSOCIATED PERMITS. I UNDERSTAND MY RESPONSIBILITIES & WILL
COMPLY WITH ALL PRECAUTIONS.
2. I WILL REMAIN ON SITE AS DEFINED BY THE PERMIT APPLICANT & OBTAIN NECESSARY 12 HOUR SHIFT
CHANGE ENDORSEMENTS.

NAME: SIGNATURE:
CONTACT NUMBER: DATE & TIME:
AUTHORISING BY ISSUING AUTHORITY

I HAVE EXAMINED THE PERMIT: JOB SAFETY PLAN/ RISK ASSESSMENT ATTACHED AND THE WORK
DESCRIBED IS AUTHORISED FOR THE PERIOD:

FROM DATE: TIME:

TO DATE: TIME:
NAME: SIGNATURE:
NOTES FROM ISSUING AUTHORITY:
AREA / ISSUING AUTHORITY ENDORSEMENT

DATE

TIME FROM

TIME UNTIL

INITIAL

LIFE SAVING RULES

PERMIT CANCELLATION/ HANDOVER

I HAVE VISITED AND INSPECTED THE WORKSITE. THE WORK DISCRIBED IN ABOVE SECTION
IS COMPLETE AND MATERIALS/ TOOLS/ EQUIPMENT HAVE BEEN REMOVED & AREA CLEANED

IS TO CONTINUE ON ANOTHER PERMIT

PERMIT HOLDER: DATE & TIME:
(NAME & SIGNATURE)
AREA AUTHORITY: DATE & TIME:
(NAME & SIGNATURE)