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PERMIT CHECK POINTS

PTW NO :
……………….
Validity From:_________
Hot Work

Hot work are all activities in which welding, brazing,soldering, cutting, grinding, asphalt work etc… is perfo
and/ or individual plant sections containing combustible materials such as timber, cables, paints, plastics, p

shall be coordinated in such a manner that the exposure of personnel to hazards or the impairment of plant
shall therefore be ensured that any activities associated with the release of combustible substances, vapou
not performed for the duration set out in the hot work permit and in the area for which said hot work permit

Measure Rem
1 Instruction to Personnel regarding hazards and working procedure (like atten
2 Notification To Other Contractors YES
3 Escape routes to be provided and kept clear YES
4 Combustible material to be removed / covered YES
Has the area immediately below the work spot been cleared / removed of oil,
5 YES
grease & waste cotton etc…
6 Has gas connection been tested in case there is gas valve / gas line nearby. YES
7 Have fire extinguisher been kept handy at site. YES

8 Has tin sheet / wet gunny bags/ fire retardant cloth/ sheet been placed to contain
YES
hot spatters of welding / gas cutting.
9 Has water hose connection been made for continuous water spray, if required YES
10 Have all drain inlets been closed. YES

11 Whether welding machine checked for fitness and gas cutting set for flash back
YES
arrestor and NRV.

12 The welding machine cable is not lying in the movement area and is ensured for
YES
preventing from any sort of damage
13 Any other Precautions taken:- …………………………………………………………………………………………

Tick As Applicable

Special Fire extinguisher at place Security Guard / Helper Explosion Potensial Test reqd.

Bucket Of Sand Fire watch Non Sparking Tools

Post Work Fire inspection Communication Provision Of low Voltage Light

Fire resistant clothing Electrical Tools Grounded Flying Sparks protection


PERMIT CHECK POINTS
Fire resistant clothing Electrical Tools Grounded Flying Sparks protection

Respirators Safety Harness With Life line Ventilation

Barriers, Warning signs Miscellaneous

Additional Safety Precaution / Remarks :-

I have checked the above points and found conditions suitable to


undertake the work:- _____________________
Permit Applicant ( Site Enng/ Sr. Sup):- Name ( in block

Note: Hot work Permit can be ontained for One shift only & it can be extended for the immediate next shift if the work could not be completed

Note :- We the undersigned, hereby confirm to perform the above mentioned work in compliance with the relevent le
practices, site rules and regulation, and Rustomjee guidelines. Implemetation of above safety standards /precaution
responsibilty of the contractor performing the work. The site management of the Rustomjee assumes no liability in th
PERMIT CHECK POINTS
PTW NO : Location: ……………….
……………….
Validity From:___________ To:_______________

sphalt work etc… is performed directly on systems


, cables, paints, plastics, packaging materials etc...
The activities
or the impairment of plant safety can be ruled out. it
ustible substances, vapours, gases and liquids are
hich said hot work permit applies.

Remarks
(like attendence record )
NO N/A
NO N/A
NO N/A

NO N/A

NO N/A
NO N/A

NO N/A

NO N/A
NO N/A

NO N/A

NO N/A

………………………………………………………..

n Potensial Test reqd. Bucket of water

Non Sparking Tools Fire Hose prepared

Of low Voltage Light Escape route + kept Clear

ing Sparks protection


PERMIT CHECK POINTS
ing Sparks protection

Ventilation

________________________________________
Sup):- Name ( in block letters) / date/ signature

f the work could not be completed with in one shift.

mpliance with the relevent legal requirements, industrial


safety standards /precautions shall be the sole
mjee assumes no liability in this regard.
PTW NO : ……………….
Validity From:________
Permit to open manhole cover, cut-out &lift shaft gril

Location of manhole, cut-out & lift shaft grill & guardrail etc..: _______________________________________

Permission required to temporarily open manhole cover, cut-out & lift shaft grill & guardrail etc... :

Date: _____________ From hrs. ____________ to hrs. ___________

Measure Re
1 Instruction to Personnel regarding hazards and working procedure (like atte
2 Notification To Other Contractors YES
Separate routes for man and material entry to be provided and kept clear bellow
3
cut-out,& lift shaft grill & guardrail YES
4 Has the area been fenced/barricaded and signage's displayed. YES

5 Have the red light / reflectors/ red flags been displayed.( Specially at night)
YES
6 Has required fall protection PPE provided YES
Has existing structures, buildings, installation like gas, electrical service station
7
etc.. Disconnected ( Applicable for confined space / manhole opening) YES
8 Has full time supervisor deployed to supervise the work YES
9 Any other Precautions taken:- ……………………………………………………………………………………………

Tick As Applicable

Barricades, warning signs Banksman / Flag man Dewatering pump

Safety harness with lifeline Cross over Road block

Equipment's Fitness Competent Operator Respirators / Gas mask

Wooden Handled tools Ventilation Miscellaneous

Risk Assessment Illumination Life line with fall grab arrestor


Additional Safety Precaution / Remarks :-

To be filled in by Engineer-incharge / Site-in-charge permitting to open the manhole cover,


cut-out & lift shaft grill and guardrails after ensuring that safety precautions have been
made at the proposed area for opening the cover.:-
(Permitte / Site Eng./ Sr. Sup):- Name ( in block lette

Restoration:
To be filled in and certified by person who had asked for the permission to open the Manhole Cover
Guardrails stating that the manhole cover, cut-out & lift shaft grill and guardrails has been placed back in po
_________(date) at ___________hrs. after the work was completed and safety arrangements removed and th

( Name of Permitted / Site Eng./ Sr. Sup):- __________________


PTW NO : ………………. Location: ……………….
Validity From:______________ To:_______________
ut-out &lift shaft grills & guardrails

__________________________________

guardrail etc... :

___________

Remarks
(like attendance record )

NO N/A

N/A
NO
NO N/A

N/A
NO
NO N/A

N/A
NO
NO N/A

……………………………………………………..

Dewatering pump Escape route + kept Clear

Road block Shoring

Respirators / Gas mask Eye protection

Miscellaneous Method Statement

ine with fall grab arrestor


):- Name ( in block letters) / date/ signature

open the Manhole Cover, cut-out & lift grill and


as been placed back in position properly on
ngements removed and the area is cleared.

up):- ________________________________