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    Work Permit Format

    Uploaded by

    Aejaz Mujawar
    This document is a hot work permit that must be used for any process generating heat, sparks, or flames that could ignite combustible materials. It details the location and timing of hot work, verifies required precautions have been taken, and includes a checklist of safety measures that must be confirmed such as ensuring fire protection equipment is available, combustible materials have been removed or protected, and ventilation is adequate. Signatures are required from those performing, supervising, and authorizing the hot work.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    Work Permit Format

    Uploaded by

    Aejaz Mujawar
    422 views12 pages
    This document is a hot work permit that must be used for any process generating heat, sparks, or flames that could ignite combustible materials. It details the location and timing of hot work, verifies required precautions have been taken, and includes a checklist of safety measures that must be confirmed such as ensuring fire protection equipment is available, combustible materials have been removed or protected, and ventilation is adequate. Signatures are required from those performing, supervising, and authorizing the hot work.

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    Work permit format

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    This document is a hot work permit that must be used for any process generating heat, sparks, or flames that could ignite combustible materials. It details the location and timing of hot work, verifies required precautions have been taken, and includes a checklist of safety measures that must be confirmed such as ensuring fire protection equipment is available, combustible materials have been removed or protected, and ventilation is adequate. Signatures are required from those performing, supervising, and authorizing the hot work.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    422 views12 pages

    Work Permit Format

    Uploaded by

    Aejaz Mujawar
    This document is a hot work permit that must be used for any process generating heat, sparks, or flames that could ignite combustible materials. It details the location and timing of hot work, verifies required precautions have been taken, and includes a checklist of safety measures that must be confirmed such as ensuring fire protection equipment is available, combustible materials have been removed or protected, and ventilation is adequate. Signatures are required from those performing, supervising, and authorizing the hot work.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 12

    DANGER !!

    HOT WORK PERMIT


    This Permit must be used for :

    Gas or Electric Cutting or Welding Burning


    Brazing or Torch Soldering Abrasive Grinding
    Any process generating heat, Sparks or Flames that are potential ignition source

    Description of the Job being carried out

    Hot Work Location :

    Date of Issue : Time :


    Permit Expires : Time :
    Permit Extended upto: Time :

    Pre-Work Inspection & Arrangements - Before Starting Hot Work :


    I verify the location where this hot work will be done has been evaluated and personally
    inspected. Precautions are identified on the Hot work checklist.
    Signature Name
    Person Performing Hot Work - Contractor Welder
    Person Supervising Hot Work - Contractor Supervisor/Fire watch
    Person issuing Hot work permit
    Person Authorising Hot Work - EHS manager /Project Manager

    HOT WORK CHECKLIST


    Mark as :" YES" OR "N/A" - Not Applicable

    Fire Hose and Portable Fire Extinguisher is available.


    TICK WHERE REQUIRED: DCP / CO2 / FOAM / WATER
    Workers in Adjacent Areas are protected from potential exposure to flash
    Ventilation adequate to control exposure to airborne fumes, gases or particulates
    Paint or coating containing heavy metal, epoxy or urethanes have been removed
    at least 5 meters away from the area where heat is to be applied.

    Flammable Liquids, dusts and chemical containers removed


    Flammable or explosive atmosphere in the area is eliminated.
    Check area with explosivemeter every____mins. when there a potential flammable gas/liquid is likely
    NO HOT WORK PERMITTED IF METER READS > 10 %
    All Combustibles removed where possible. Otherwise protect with Fire-resistant
    Tarps, Metal Shields, Wetting or any other appropriate means.
    All wall & floor openings are covered.
    Fire resistant tarps suspended beneath elevated work & area cordoned off.

    Emptied, cleaned, purged or otherwise safeguarded


    Confined space entry identified & entry permit issued

    Supervisor to be present during and for 30 minutes after hot work


    Does the supervisor know fire-fighting
    Supervisor to monitor adjoining areas
    Periodically check area every _______ minutes.

    Signature Name
    Person Performing Hot Work - Contractor Welder
    Person Supervising Hot Work - Contractor Supervisor/Fire watch
    Person issuing Hot work permit
    Person Authorising Hot Work - EHS manager /Project Manager

    # List any unusual incident that occurred during the work process. Time completed :____________ AM /PM

    Issue A dated 19/09/2011 EISENMANN INDIA


    al ignition source

    nd personally

    CHECKLIST

    ses or particulates
    ve been removed

    ammable gas/liquid is likely


    ith Fire-resistant

    rdoned off.

    Time completed :____________ AM /PM


    GENERAL WORK PERMIT
    EISENMANN INDIA Pvt. Ltd.

    LTT WORKING AT HEIGHT CONFINED SPACE ENTRY


    WORK PERMIT WITH OUT OPEN FIRE EXISTING CONTROL AUDIT

    1) The permit does not relieve the users of his responsibility with respect to safety.
    2) The applicant has to return all copies of permit to Permit issuer after the completion of the job / at the end of work
    3) Make sure that each worker on job understands the safety aspects and operational aspects.
    4) The applicant is not authorised for making utility connections viz. Electical, Gas, Air, Nitrogen etc on his own if rea
    5) Stop work and come out of confined spaces in case of emergency announcement, even in case of mock drills.
    6) In case of emergency, leave the plant and assemble at main gate or material gate.
    7) Validity of the permit is upto the end of the shift. The same can be renewed upto max. 3 working days.
    8) Name of all the employees involved in the job should be clearly written. ( Use extra page if required.)
    9) The applicant /Contractor shall make arrangements for his own PPE

    To be Name of Permit Applicant: -


    filled Detailed job description:
    in by
    the execu-
    ting
    departm-
    ent
    Names of the persons carrying out the job:

    Utility Required Air Water Nitrogen Electricity NA

    PPE Req Helmet Ear protection Dust mask Sleeves


    Harness Faceshield Gumbooots Apron Others:

    Measures to be taken by Issuer before signature


    Yes No NA
    1) Concerned people are notified
    2) Floor condition, pits, openings covered
    3) Area Isolation done
    4) Equipment Shutdown as per
    4) Lockout Tagout Try procedure.
    5) Equipment isolated.
    6) Pipelines/Equipment is drained and free of pressure
    7) Electical supply isolated
    8) Equipment is washed with water
    9) Air / N2 Purging is done
    10) For Confine space entry, enclosure to be checked for
    Oxygen. Entry permitted only if Oxygen is in 19% - 21%
    Tested By :
    11) Ventilation, illumination provided
    12) Special instrument, measures, precaution/procedure -
    12) Special instrument, measures, precaution/procedure -

    Issuer Name
    Signature
    After Completion of Job
    back / Taking over)
    Remarks, If any Yes/No/NA
    1. Job is completed safely and Housekeeping done.
    2. Removed lockout / tagout, Utilities connections restored
    3. Reactivation of safety devices if any, Guards put back
    4. Re-energised system and checked by Trial.
    Issuer Name
    Applicant Name

    Issue A dated 19/09/2011 EISENMANN INDIA


    T
    d.

    D SPACE ENTRY PM / WATER BLASTING


    CONTROL AUDIT

    ion of the job / at the end of working hrs. Applicant may retain original copy.
    nal aspects.
    Air, Nitrogen etc on his own if ready outlet is not provided. Utility OE s are exempted.
    nt, even in case of mock drills.

    max. 3 working days.


    tra page if required.)

    Dept / Contractor:
    Location:
    Valid from: Date Time

    Valid up to: Date Time

    Extended
    Date
    Valid From
    Valid Upto
    Signature

    Authorized by:-____________Connected by:-____________

    Heat / Electrical / Chemical Resistance Gloves

    Measures to be taken by Applicant before signature


    Yes No NA
    1) Locks / Tags applied
    2) Lances, Hoses, Cables etc. checked
    3) Equipment checked for motion by Tryby
    4) Use of Ladder for working at height
    a) Fall Barrier Present
    b) Landing platform avaialble
    c) Ladder locking arrangement done
    d) Safe work load
    e) Lifeline / Fall Barrier / Grating available
    5) Use of Scaffolding
    a) Scaffolding tied to Rigid support
    e) Lifeline / Fall Barrier / Grating available
    c) Safety belt with fall arrestor provided
    d) Crossmember provided on scaffolding
    6) PPE provided to work persons
    7) Attendant provided with necessary
    lifelines / communication aids.
    Name of attendant
    Applicant Name
    Signature (Handing

    Remarks, If any

    Signature
    Signature

    EISENMANN INDIA
    GENERAL WORK PERMIT

    OWENS CORNING (INDIA) LTD. TALOJA

    LOCKOUT / TAGOUT WORKING AT HEIGHT CONFINED SPACE ENTRY


    WORK PERMIT WITH OUT OPEN FIRE OTHERS

    1) The permit does not relieve the users of his responsibility with respect to safety.
    2) The applicant has to return all copies of permit to Permit issuer after the completion of the job / at the end of work
    3) Make sure that each worker on job understands the safety aspects and operational aspects.
    4) The applicant is not authorised for making utility connections viz. Electical, Gas, Air, Nitrogen etc on his own if rea
    5) Stop work and come out of confined spaces in case of emergency announcement, even in case of mock drills.
    6) In case of emergency, leave the plant and assemble at main gate or material gate.
    7) If more than one person / dept. is working on the same equipment, each one should put individual lock / tag on th
    8) Validity of the permit is upto the end of the shift. The same can be renewed upto max. 3 working days.
    9) Name of all the employees involved in the job should be clearly written. ( Use extra page if required.)
    10) The applicant /Contractor shall make arrangements for his own PPE

    To be Name of Permit Applicant: -


    filled Detailed job description:
    in by
    the execu-
    ting
    departm-
    ent
    Names of the persons carrying out the job:

    Utility Required Air Water Nitrogen Electricity NA Authorized by:-_______

    PPE Req Helmet Ear protection Dust mask Sleeves Heat / Electrical / Ch
    Harness Faceshield Gumbooots Apron Others:

    Measures to be taken by Issuer before signature Measures to be taken b


    Yes No NA
    1) Concerned people are notified 1) Locks / Tags applied
    2) Floor condition, pits, openings covered 2) Lances, Hoses, Cabl
    3) Area Isolation done 3) Equipment checked f
    4) Use of Ladder for wo
    Lockout Tagout procedure. a) Fall Barrier Present
    5) Equipment isolated. b) Landing platform ava
    6) Pipelines/Equipment is drained and free of pressure c) Ladder locking arrang
    7) Electric 4) Equipment Shutdown as per d) Safe work load
    8) Equipment is washed with water e) Lifeline / Fall Barrier
    9) Air / N2 Purging is done 5) Use of Scaffolding
    10) For Confine space entry, enclosure to be checked a) Scaffolding tied to Ri
    for Oxygen. Entry permitted only if Oxygen is in 19% - e) Lifeline / Fall Barrier
    21% Tested By : c) Safety belt with fall ar
    11) Ventilation, illumination provided d) Crossmember provid
    12) Special instrument, measures, precaution/procedure - 6) PPE provided to work
    12) Special instrument, measures, precaution/procedure -
    7) Attendant provided w
    lifelines / communicat
    Name of attendant
    Issuer Name Applicant
    Signature of Job
    After Completion
    (Handing back / Taking over)
    Remarks, If any Yes/No/NA Remarks, If any
    1. Job is completed safely and Housekeeping done.
    2. Removed lockout / tagout, Utilities connections restored
    3. Reactivation of safety devices if any, Guards put back
    4. Re-energised system and checked by Trial.
    Issuer Name Signature
    Applicant Name Signature
    PM / WATER BLASTING
    EXISTING CONTROL AUDIT

    e job / at the end of working hrs. Applicant may retain original copy.

    ogen etc on his own if ready outlet is not provided. Utility OE s are exempted.
    in case of mock drills.

    ndividual lock / tag on the equipment.


    working days.
    if required.)

    Dept / Contractor:
    Location:
    Valid from: Date Time

    Valid up to: Date Time

    Extended
    Date
    Valid From
    Valid Upto
    Signature

    Authorized by:-____________Connected by:-____________

    Heat / Electrical / Chemical Resistance Gloves

    Measures to be taken by Applicant before signature


    Yes No NA
    1) Locks / Tags applied
    2) Lances, Hoses, Cables etc. checked
    3) Equipment checked for motion by Tryby
    4) Use of Ladder for working at height
    a) Fall Barrier Present
    b) Landing platform avaialble
    c) Ladder locking arrangement done
    d) Safe work load
    e) Lifeline / Fall Barrier / Grating available
    5) Use of Scaffolding
    a) Scaffolding tied to Rigid support
    e) Lifeline / Fall Barrier / Grating available
    c) Safety belt with fall arrestor provided
    d) Crossmember provided on scaffolding
    6) PPE provided to work persons
    7) Attendant provided with necessary
    lifelines / communication aids.
    Name of attendant
    Name
    Signature

    Remarks, If any

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