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Hot Work Permit

Hot Work Permit

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M.V./S.S.: POSITION / PORT
VALID FOR FROM hrs DATE:
PERIOD * TO hrs DATE:
Specific Location, Description of Work and Equipment to be used:
Special Precautions
Personnel Assigned to Work:
Officer Responsible for Supervision of Work:
Officer Responsible for Safety:
Agreement Received From Office (where applicable):
Date / time received:
From whom (name):
By method (i.e. e-mail, phone etc)
We are satisfied that the hotwork permit instructions, and checklist requirements have been complied with, and that it is safe to proceed with the work as described.
N.B. Any alteration to the conditions required to comply with the checklist items will invalidate this permit.
Officer Responsible for Supervision of Work Signature:
Officer Responsible for Safety Signature:
Master’s Signature:
I am satisfied that the work described has been completed on or before the end of the above mentioned period*
and that all persons under my supervision, materials and equipment have been withdrawn.
Officer Responsible for Supervision of Work Signature:  
Date: Time:
*Valid period not to exceed 8 hours.

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CHECKLIST
YES NO REMARKS
1.0 Have the following operations
If applicable been suspended:
¨ Cargo
¨ Ballast
¨ Tank Cleaning
¨ Gas Freeing
¨ Purging
¨ Inerting
2.0 Is the Oxygen Content of the space 21% and has the company
Enclosed Space Entry Permit
been issued?
3.0 Has the space been gas freed to
Less than 1% L.F.L?
4.0 Has the Work Area been checked
with a Combustible Gas Indicator,
for Hydrocarbon Vapours?
5.0 Has the surrounding area been
checked with regard to
Combustible Flammable Materials
and Gasses?
6.0 Has the surrounding area been
cleaned and rendered safe and if
applicable continuously ventilated?
7.0 Are the adjacent spaces clean and
Gas Free or Inerted?
8.0 Have arrangements been made to
check the work area for
combustible gas at 2 hourly
intervals whilst the work is in
progress?
9.0 Are the pipelines in the space or
entering the space clean and
additionally Gas Free, Inerted or
filled with clean water or blanked?
10.0 Is all electrical equipment
Isolated?
Officer Responsible for Safety Signature:
Masters Initials:

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CHECKLIST (Cont)  
YES NO REMARKS
11.0 Is all Electric Welding Equipment
securely Earthed?
12.0 Is any Oxy-Acetylene or other
Burning Equipment being used in
safe working order?
13.0 Is additional Fire Protection in
place?
14.0 Are Smoking Regulations in force?
15.0 Has Walkie/Talkie emergency
communication been established?
16.0 Has the relevant management
office  approval if applicable been
obtained  for this Hotwork?
17.0 Has Wx condition monitored for
Duration of work
17.0 Has a Risk Assessment been
carried out?
Officer Responsible for Safety Signature:
Masters Initials:  
   

The Responsible officer shall ensue, at an interval not exceeding 2 hrs, that there are no alterations to above conditions. Repetitive checks are to be recorded in the table mentioned below:

 

After 2 hrs of Commencing Hot work After 4 hrs of Commencing Hot work After 6 hrs of Commencing Hot work
Name
Rank
Signature

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