Title Page
Permit Information
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Precision Group Energy Services
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Specific Equipment To Be Worked On?
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Work Description/Purpose:
Special Precautions
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Pre-job safety meeting (JSA) held with all affected personnel?
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Have all combustible and flammable materials within 35 feet of hotwork area, been relocated or protected?
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Is the atmosphere acceptable for preforming hotwork?
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Has the affected equipment been isolated?
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Have all energy sources been identified and isolated?
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Have all ignition sources been identified?
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Has an inspection been completed with person performing the hotwork to identify potential fire/explosion hazards?
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Has fire watch been trained in assigned duties?
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Have all floor openings/cracks where sparks could ignite material below been protected?
Atmospheric Testing
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Gas Alert Max XTII
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Serial#:<br>Calibration Date:
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Authorized Gas Tester:
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Frequency:
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Readings:
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Personel Protection
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- Fire Exstinguisher
- Lockout/Tagout
- Non-Sparking Tools
- Fall Protection
- Emergency Exits
- SDS Review
- Grounding/Bonding
- Emergency Rescue
- Classified Electrical Area
Authorized Signatures
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