Form 0005: Hot Work Permit: Section - I Details of The Permit Reciver

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GAMA GÜÇ SİSTEMLERİ MÜHENDİSLİK VE TAAHHÜT A. Ş.

DISI – MUDAWARRA TO AMMAN WATER CONVEYANCE SYSTEM PROJECT


FORM 0005: HOT WORK PERMIT

PERMIT No: DATE:


Section – I DETAILS OF THE PERMIT RECIVER
Project / Section Location (s)
Permit Issuer name Contact Number
Permit receiver Contact Number
Name of the Welder ID number
Safety In charge Contact Number
Section – II PERMIT VALIDATIONS
Date issued & Time Issued Valid Till
Extended Date & Time Valid Till
Permit issuer should be engineer of the activity to be done
HOT work permit shall not exceed its duration for more than seven (7) days.
Work Permit shall be renewed on the Eighth (8 th) day WITHOUT FAIL
Section – III PREREQUISITE (Work May be stopped if one of the following is not complied with)

 for YES and X for No Yes No NA  for YES and X for No Yes No NA
A Flammable Materials removed from location K Appropriate Working Platform
B Welding terminal insulation L Safety/Warning Signs in place
C Condition of the welding cables M Adequate Ventilation
D Area of work clean and dry N Adequate illumination
E Appropriate Fire Extinguisher Provided O Flash Back arrestors - Gas Cylinders
F Fire marshal trained in using fire extinguisher P Cylinders Kept in trolley and secured
G Fire Retardant Blankets Provided Q Regulators & Leads in good condition
H Fire Watch Personal R Gas test required
I Area barricaded
Area to be monitored for first hour and after three hours
J Appropriate PPE Provided

Declaration by the Permit Receiver Name and address of employer

I_________________ representing _________________ herby Company Name :……………………………………………


declare that I have checked the location and the welder has been Nature of Job :……………………………………………….
briefed about the hazard involve and a toolbox talk given on
P.O.Box No………………. Tel.No…………………………
control measures to ALL Hazards involved in the activity and he
will comply with the requirement. Fax No…………………… Jordan ……………………….

Date:……/……/…… Name; ……………. Signature; Contact Number (Site Safety officer)………………………..


Section IV PERMIT APPROVAL
Work shall be carried out ONLY after complying with the precautions given in Section – III of this Permit.
The permit is valid up to _______ hrs. on / / . It has to be ensured that the employee executing the Job has a copy of
the permit at all times during work. No equipments shall be left unattended at any time whatever the reason may be. All above
precaution in section III to be reviewed and ensure it comply with otherwise not starts work unless changed to safe condition.

Name of the Engineer:…………………………….. Signature …………………………… Date …….../…..…./……..

PERMIT COPY DISTRIBUTION (tick appropriate boxes):


Project Manager Engineer Electrician Supervisor

Copy of work permit should be kept in workplace area

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