Title Page
-
Site conducted
-
Conducted on
-
Prepared by
-
Location
-
Document Number
Company Details
-
Company Name
-
Company Contact Number
Contractors Names and Occupation
-
Name
-
Occupation
Duration of Permit
-
Start Time
-
Finish Time
Hazards to be controlled
-
Pressure System/Stored Energy
-
Electrical Systems
-
Hot Work
-
Confined Space Entry
-
Working at Height
-
Lifting Operations
-
Working on Fire Systems
-
Bulk Chemical Handling
-
Other
-
Assessors Name
Hazard Descriptions
-
Hazard
-
Control Measure
-
Additional Information (If applicable)
Work Details
-
Work Location
-
Job Description
Risk Assessments / Method Statements
-
Associated documents reviewed and approved
-
Assessors Name
PPE Requirements
-
Hearing Protection
-
Eye Protection
-
Foot Protection
-
Head Protection
-
Hand Protection
-
Hi-Visibility Protection
-
Respirator Protection
-
Protective Clothing
-
Safety Harness
-
Other
Hot Works
-
This Hot Work Permit is required for any temporary operation involving open flames or producing heat
and/or sparks. This includes, but is not limited to: Brazing, Cutting, Grinding, Soldering, Torch Applied
Roofing and Welding.
Required Precautions Checklist
-
Available sprinklers, hose streams and extinguishers are in service/operable
-
Hot work equipment in good repair.
Requirements within 10 m (35 ft) of work
-
Flammable liquids, dust, lint and oily deposits removed.
-
The explosive atmosphere in area eliminated.
-
Floors swept clean.
-
Combustible floors wet down, covered with damp sand or fire-resistive sheets.
-
Remove other combustibles where possible. Otherwise, protect with fire-resistive tarpaulins or metal shields.
-
All wall and floor openings are covered.
-
Fire-resistive tarpaulins suspended beneath work
-
Protect or shut down ducts and conveyors that might carry sparks to distant combustibles.
Work on walls, ceilings or roofs
-
Construction is non-combustible and without combustible covering or insulation.
-
Combustibles on the other side of walls, ceilings or roofs are moved away.
Work on enclosed equipment
-
Enclosed equipment cleaned of all combustibles
-
Containers purged of flammable liquids/vapours.
-
Pressurised vessels, piping and equipment removed from service, isolated and vented.
Fire watch/hot work area monitoring
-
Fire watch will be provided during and for 60 minutes after work, including any coffee or lunch breaks.
-
Fire watch is supplied with suitable extinguishers, and where practical, a charged small hose.
-
Fire watch is trained in the use of the equipment & in sounding alarm
-
Monitor Hot Work area for 2 hours after the job is completed.
-
Permit period not to exceed one (1) shift. Work area & all adjacent areas to which sparks & heat might have spread were inspected during the fire watch period and were found fire safe.
Confined Space
-
Purpose of Entry
-
Communication Procedures
Rescue Procedures
-
Click + to add rescue procedures
-
Enter reference number and details here
Pre-Work
-
Indicate whether the following items are completed and reviewed before entry
-
Lockout/Deenergize/Tagout
-
Line(s) Broken-Capped-Blank
-
Purge-Flush and Vent
-
Ventilation
-
Secure Area (Post and Flag)
-
Breathing Apparatus
-
Resuscitator - Inhalator
-
Standby Safety Personnel
-
Full Body Harness Body with D ring
-
Full Body Harness Body with D ring
-
Emergency Escape Retrieval Equipment
-
Lifelines
-
Fire Extinguishers
-
Lighting (Explosive Proof)
-
Respirators (Air Purifying)
Completion
-
Full Name, Signature and Position of Person Involved (e.g. Sheen Meyer - Entrant)
System Isolation Details
- Lock Information
-
Lock No
-
Applied By
-
Removed By
Signature Page
-
Accepting responsibility for work being carried out in line with DRB QHSE Standards then that all tools and equipment be removed and the work environment complies with HSE Law.
-
Contractor Acceptance and Sign Off
-
DRB Acceptance and Sign Off
