STANDARD SPECIFICATION FOR
HEALTH, SAFETY &
ENVIRONMENTAL MANAGEMENT
AT CONSTRUCTION SITE
FORMAT NO. : ABB/EIL/HSE-18, REV 00
Page (1 of 2)
WORK PERMIT FOR HOT WORK
Project: DCS & HV Package For BPCL LPG Terminal, Haldia
Permit No :
This permit is to be applied by Contractor’s representative or person-in charge appointed full-time to oversee the work
on site. All PTW is to be applied 1 day in advance. No one is allowed to resume work unless PTW is approved. A copy of
PTW is to be displayed at work location. This PTW is considered void or cancelled should any of the safety measures
there-under is violated.
A: Application – To be completed by Permit Holder Representative
Name of Supervisor:
Location of work :
Description of work :
Contact No
Date & Time of work From
:
Inspection checklist
No of
workers
To
YES/NO/NA
S/No
Safety measures
1
2
3
Has all equipments and electrical wires checked free from defects?
Is work area confirmed clear from flammable or combustible substances?
Is electrical cutting/grinding tool secured with safety guard?
4
Is work area bright enough?
5
Is fire extinguisher available within reach?
6
Is fire watchman available?
7
Is fire protective blanket provided?
8
Is gas cylinders secured in a trolley or cage?
9
Is flashback arrestor available?
10
Ensure no incompatible work.
11
Is AC welding set fitted with proper voltage shock prevention (LVSP)?
12
Is welding set secured with earthing?
13
Is electrode holders ensured with insulation and not exposed to metal
parts?
To ensure electrode are detached from its holder when not in use?
14
Remarks
Check:Yes =OK No=Not OK NA= Not applicable
Remarks: To indicate any defect found or other comments
Name of Applicant
Signature
Date
Time
STANDARD SPECIFICATION FOR
HEALTH, SAFETY &
ENVIRONMENTAL MANAGEMENT
AT CONSTRUCTION SITE
FORMAT NO. : ABB/EIL/HSE-18, REV 00
B: Review & Endorsement – To be completed by Safety Department
Name of Safety Coordinator/Supervisor
Signature
Page (2 of 2)
Date
Time
Comment or additional safety measures to be observed by Applicant :
C: Approval – To be completed by Shop Manager/ In charge.
Name of SM/In charge
Signature
Date
Time
Date
Time
Review &
Endorsement by
safety
department
Approved by
shop
Manager/
Construction
manager
D: Completion of work – To be completed by Applicant
(housekeeping conducted and work area is safe for other user)
Name of Applicant
Signature
GRANT OF PERMIT AND EXTENSIONS
Sl. No.
Validity Period
From_______
Work Time
From______Hrs.
To________
To______Hrs.
Initiator
(Supervisor of
Contractor)