HOT WORK PERMIT Revisi 1
HOT WORK PERMIT Revisi 1
HOT WORK PERMIT Revisi 1
No. Permit :
A. APLIKASI PENGAJUAN DAN SAFETY PRECAUTION CHECKLIST BY WORKSections
EXCECUTION AUTHORITY
Date of Applicati
Name Signature Position
Filed By
Location/Work Area : Job Duration From Hours :
Supervisor Name : 1. 2. 3.
Checks
Safety Precaution Checlist By Contractor Supervisor : Checked By
Yes No
connection)
2. All 3 phase electrical equipment has passed the "Tools & Equipment
Inspection Checlist" before use
3. The entire electrical supply to the electrical equipment must have a
minimum of double insulation & elcb connected
4. The return Current Load relationship directly to the subject being
welded to prevent splashing elsewhere
7. Gas tourch & gas hose should be removed from the confined space
area & regulator removed from gas cylinder at rest and the work
completed
B Safety Precaution
1. Check Checlist
the Personal OlehEquipment
Protective Area Authority (Performed By SPV/HSE)
(PPE) Needed 2. Check The Safety E
Dust Mask
Helmet, Safety shoes Work Vest/Life Jacket Portable Gas Det
Fire extinguisher
Glasses/Goggles Chemical Suit/Acid Suit Welding Mask
B
Cotton/Leather Gloves
High Temperature Gloves Full Body Harness Other : Life line
Full Face Shield
Gas Mask With Filter Flood Light for w
Boot/PVC Anti-spark equip
(Non Sparking To
PVC Apron Bunker Suit/Fire Air Remover
Retardant Clothing Fire Blanket
Checks
3. Safety
A. WhetherPrecaution
jsa/HIRADC
Check
has
List
been
: approved by the relevant parties Checked By
Yes No
B. B. Is the equipment
Attached done LOTO
with a socialization & Inserting/Removing
attendance list Blind
Procedure?
C. Continuous measurement of test gases? If "Yes" recording is done
every 1 hour
Yes No Approval
1. The whole work has been completed Date
2. Work resumes "If Yes a new permit is created and re-inspected" Time
3. The work area and equipment have been cleaned
Signature & Name
4. Work postponed/Cancelled
UTHORITY
Date of Application
Date worked on
Until
ed By Description
Portable
Fire Gas Detector
extinguisher tube 5 kg Other :
Life line
Flood Light for work at night
Anti-spark equipment
Non Sparking Tools)
Air Remover
ire Blanket
ed By Description
O2 : % LEL : %
on
ioned above:
Nama Pengawas : 1. 2. 3.
Pemeriksaan
Safety Precaution Checlist Oleh WEA : Diperiksa Oleh
Ya Tidak
1. Insulasi dari kabel & connector dalam kondisi baik (Tanpa
sambungan)
2. Seluruh peralatan listrik 3 phase telah lulus "Tools & Equipment
Inspection Checlist" sebelum digunakan
3. Seluruh supply listrik ke peralatan listrik harus memiliki minimal
double insulasi & terhubung ELCB
4. Hubungan The return Current Load langsung ke subjek yang sedang
di las untuk mencegah percikan ke tempat lain
5. seluruh mesin las AC& Stress Relieving harus digrounding dengan
sempurna
6. Amankan silinder gas dalam bucket, jauh dari percikan api & tutupi
bagian regulator gas menggunakan fire proof sheet/fire blanket
7. Gas tourch & selang gas harus dikeluarkan dari area confined space
& regulator dilepaskan dari silinder gas saat istirahat dan pekerjaan
selesai
8. Exhaust fan harus digunakan jika hotwork dilakukan di dalam
confined space
9. Peralatan Non Instrically Safe sudah diinspeksi & Disetujui sesuai
"Tools & Equipment Inspection"
10. baricade area kerja, sediakan rambu peringatan & pembatas
sebelum bekerja
11. Apakah tabung gas berisi Acetylene/LPG/Hydrogen/Oxygen
digunakan? Jika "Ýa" harus dipasang 2 flash back arester pada out put
regulator dan input gun
Dengan Ini Saya Selaku DM WEA Menyetujui Pengajuan Confined Space Permit Ini
(Nama, Id No, T
B Safety Precaution Checlist Oleh Area Authority (Dilakukan Oleh SPV/HSE)
B
1. Cek Alat Pelindung Diri (APD) Yang Dibutuhkan 2. Cek Peralatan Safety Y
Helmet, Sepatu Safety Masker Debu Work Vest/Life Jacket Portable Gas Detecto
Kacamata/Goggles Chemical Suit/Acid Suit Welding Mask Tabung APAR 5 kg
Sarung Tangan Katun/Kulit Full Body Harness Lainnya : Life line
Sarung Tangan Temp. Tinggi Full Face Shield Lampu "Flood Light"
pekerjaan dimalam h
Sepatu Boot/PVC Masker Gas Dengan Filter Peralatan anti percika
(Non Sparking Tools)
PVC Apron Bunker Suit/Pakaian Air Remover
Tahan Api Fire Blanket
Pemeriksaan
3. Safety Precaution Check List : Diperiksa Oleh
Ya Tidak
A. Apakah JSA/HIRADC sudah disetujui oleh pihak terkait
Dilampirkan beserta daftar hadir sosialisasi
B. Apakah peralatan dilakukan LOTO & Inserting/Removing Blind
Prosedur?
C. Pengukuran gas tes secara kontinyu? Jika "Ya" pencatatan dilakukan
setiap 1 jam
D. Initial Gas Tes Oleh
E. Menempatkan internal combustion di safe area
F. Penempatan "internal combustion engines" di safe area
G. Tidak ada pengecatan dalam radius 15 meter dari pekerjaan hot work
S/D
Keterangan
Keterangan
O2 : % LEL : %
diatas :
Pengawas yang bertugas HSE
an & Nama