Title Page
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Conducted on
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Created By:
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Location
Information
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Lewis Energy Group
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Permit Start:
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Permit End:
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Specific equipment to be worked on?
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Work Description:
Special Precautions
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JSA has been held with all personnel.
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All combustible and flammable materials within 35 feet of hotwork have been relocated or protected.
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The atmosphere acceptable for performing hotwork.
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The affected equipment has been isolated.
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Energy sources identified.
- Electrical
- Mechanical
- Hydraulic
- Pneumatic
- Chemical
- Thermal
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Ignition sources been identified
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Inspection completed with the person performing the hotwork to identify potential fire/explosion hazards.
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Firewatch is knowledgable in assigned duties.
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All floor openings/ cracks/and working conditions where sparks could ignite material below have been protected.
Precautions
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Personal Protection:
- Grounding/Bonding
- Fire Extinguisher
- Lockout/Tagout
- SDS Review
- Fall Protection
- Classified Electrical Area
- Non-Sparking Tools
- Emergency Rescue
- Emergency Exits
Atmospheric Testing:
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Gas Alert Max XTII
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Serial Number:
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Authorized Gas Tester:
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Readings:
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CONTACT SAFETY BEFORE STARTING!
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CONTACT SAFETY BEFORE STARTING!
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Oxygen%:
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If oxygen is not between 19.5 and 23.5
CONTACT SAFETY BEFORE STARTING! -
CONTACT SAFETY BEFORE STARTING!
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Additionl readings?
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CONTACT SAFETY BEFORE STARTING!
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CONTACT SAFETY BEFORE STARTING!
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Oxygen%:
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If oxygen is not between 19.5 and 23.5
CONTACT SAFETY BEFORE STARTING! -
CONTACT SAFETY BEFORE STARTING!
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Additionl readings?
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CONTACT SAFETY BEFORE STARTING!
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CONTACT SAFETY BEFORE STARTING!
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Oxygen%:
-
If oxygen is not between 19.5 and 23.5
CONTACT SAFETY BEFORE STARTING! -
CONTACT SAFETY BEFORE STARTING!
-
Additionl readings?
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CONTACT SAFETY BEFORE STARTING!
-
CONTACT SAFETY BEFORE STARTING!
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Oxygen%:
-
If oxygen is not between 19.5 and 23.5
CONTACT SAFETY BEFORE STARTING! -
CONTACT SAFETY BEFORE STARTING!
-
Additionl readings?
-
CONTACT SAFETY BEFORE STARTING!
-
CONTACT SAFETY BEFORE STARTING!
-
Oxygen%:
-
If oxygen is not between 19.5 and 23.5
CONTACT SAFETY BEFORE STARTING! -
CONTACT SAFETY BEFORE STARTING!
-
Additionl readings?
-
CONTACT SAFETY BEFORE STARTING!
-
CONTACT SAFETY BEFORE STARTING!
-
Oxygen%:
-
If oxygen is not between 19.5 and 23.5
CONTACT SAFETY BEFORE STARTING! -
CONTACT SAFETY BEFORE STARTING!
-
Additionl readings?
-
CONTACT SAFETY BEFORE STARTING!
-
CONTACT SAFETY BEFORE STARTING!
-
Oxygen%:
-
If oxygen is not between 19.5 and 23.5
CONTACT SAFETY BEFORE STARTING! -
CONTACT SAFETY BEFORE STARTING!
-
Additionl readings?
-
CONTACT SAFETY BEFORE STARTING!
-
CONTACT SAFETY BEFORE STARTING!
-
Oxygen%:
-
If oxygen is not between 19.5 and 23.5
CONTACT SAFETY BEFORE STARTING! -
CONTACT SAFETY BEFORE STARTING!
Signatures
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Person Conducting HotWork:
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Firewatch:
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Authorized Company Representative:
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Additional Signees:
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HSE Representative:
