SAFETY WORK CLEARANCE

Permit no.

Project:

Emergency Contact Nos:

Subcontractor:

BURNING/WELDING /HOT WORK PERMIT

Area : _____________________________________________________________ Date: ________________________ Time: ______________
Name of Site Engineer (Permit Requesting Authority): __________________________________________ Sign: __________________________
Name of Work Performing Contractor: _____________________________________________________________________________________
Name of Package In charge: _____________________________________ Sign: _____________________________ Date: _______________
Description of Work: ___________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Work Execution Date: _____________________________________ Time Valid from: ___________________ to ______________________
The above signing person(s) will be responsible to ensure that the above described work will be done under all the safety precautions mentioned
on the permit to work.
The following precautions are to be taken:
No.

Item

Yes

1.

Proper Access/Exit available

2.

Proper ventilation and /or lighting provided.

3.

Proper and safe scaffolding, platform, ladder provided.

4.

Welding machine located in a clean and dry area.

5.

Welding machine grounded at the equipment and proper leakage current protection device (ELCB)
provided for welding machine.

6.

Emergency STOP buttons are in working condition. Welder /Helper knows how to operate it.

7.

Welding machine input/output cables, welding holder and weld return clamp (Holder) are insulated and in
good condition.

8.

Welder & Fitter trained to connect ground/work return clamps (Holder) to work place prior to energization of
welding machine.

9.

Gas cylinders are stacked vertically and not below the welding / cutting area. Regulator key is available
with cylinder.

10.

Pressure gauges/Flash back arrestor provided and in working condition.

11.

Personal Protective equipment Minimum applicable: safety helmet, safety goggles, welding helmet, safety
shoes, leather gloves, long sleeve and nose mask -provided

12.

In case of pits, water removed from the pit and wood/rubber insulation provided.

13.

Safety signboards are in place.

14.

Adequate and Suitable nos. of fire fighting extinguisher provided.

15.

Nearby combustible material removed. Housekeeping done.

16.

Other

Not required

Name of Contractor Safety Officer: ______________________________________ Sign: __________________ Date: __________ Time: ______
Reviewed and approved by BHEL Site Engineer (Permit Issuing Authority):
Name: _________________________________________ Sign: ___________________________ Date: _________________ Time: _________
Name of BHEL Safety Representative: ______________________________________________ Sign: _________________________________
I understand the precaution to be taken as described above and as per project requirement and hereby confirm that work will be executed under
my supervision by following all precaution and Safety Rules.
Name of Work Performing Authority: _____________________________Sign: _______________ Date: _____________ Time: ___________
Permit Cancellation:
I hereby declare that the work is complete, all workers under my control have been withdrawn and the site restored to safe tidy condition.
Name of Work performing Authority: ________________________________ Sign: ________________ Date: __________ Time: _________
Name of Site Engr. (Permit Requesting Authority): _____________________ Sign: ________________ Date: __________ Time: _________
Name of BHEL Site Engr. (Permit Issuing Authority): ____________________ Sign: _______________ Date: __________ Time: __________
(This permit is valid only for the date it is issued)
Original at BHEL site

Second Copy BHEL SAFETY

Third Copy : Contractor