HOT WORK PERMIT

Project Name: Permit No.:

Date: From: To: Duration (Time): From: To:
1. Details of Work:
1.1 Name of Company:
1.2 Location of Work:
1.3 Description of Work:

1.4 Person in Charge (supervisor): No. of Workers:

1.5 Fire Watchman Name:
1.5 Equipment & Tools
to be used:
Fire Hazard Flammable/Combustible materials Caught in/Struck by

2. Hazard Dust / fumes Flying objects Flash back fire

Considerations
Electrical Hazard Noise/Skin Injury Heat, Sparks, & Slag

Additional Hazards to be present: (for further, you may use back side of this page):

Fire Extinguisher Face Shield/Goggles/Mask Fire watchman

3. Precautions &
Fire Protection Proper Ventilation Inspect Equipment’s/Tools before use Fire Blanket

Additional Precautions to be taken: (for further, you may use back side of this page):

4. Atmospheric Test: Gas test required? Yes No If yes record the results below
Name Time Flammable 0% LEL Oxygen 23.5%-19.5% H2S Signature

Remarks Regular basic PPE, availability of adequate supervision, method of statement, & risk assessment, etc., are mandatory.
Person Authorized Permit Name Position Sign Date
Permit Receiver from Sub-Contractor:
Permit Issuer from HEES:
Tick Permit Statement Person Name Sign Date
Permit date is finished, job is still Request (Receiver)
not finished, Please extend the date Approved (Issuer)
of the Permit Permit extended up to:
Request (Receiver)
Permit is closed, job is completed
Approved (Issuer)
Permit Cancellation:
Cancellation Remarks:
Cancellation Requested By: Authorized By:

HEES-PTW-06, REV-00