Fillable Printable Permit For Welding, Cutting, Or Brazing

Permit For Welding, Cutting, Or Brazing

PERMIT FOR WELDING,

CUTTING, OR BRAZING

1A. NAME OF EMERGENCY CONTACT 1B. TELEPHONE NUMBER

2. OFFICE ISSUING PERMIT

B. SPECIFIC LOCATION WITHIN BUILDING

A. BUILDING NAME

3. LOCATION

FOR PERMIT

5. SPECIAL NATURE OF WORK

4A. DATE OF WORK

4B. START TIME

a.m.

p.m.

4C. STOP TIME

p.m.

a.m.

6. ANTICIPATED HAZARD DUE TO WORK (Safety/Health/Fire)

7. LIST OF PROTECTIVE CLOTHING AND EQUIPMENT REQUIRED FOR WORK (Include personal protection and public production)

8. NAME OF PERSON PERFORMING WORK 9. NAME OF FIRE WATCH AT SITE

10. EMERGENCY PRECAUTIONS (Include type of required fire extinguisher)

11. PREWORK SITE INSPECTOR

A. SIGNATURE B. NAME AND TITLE C. DATE

12. PERMIT ISSUED BY

C. DATEB. NAME AND TITLEA. SIGNATURE

A. SIGNATURE OF POST-WORK CHECKUP INSPECTOR

13B. DATE

GENERAL SERVICES ADMINISTRATION GSA FORM 1755 (REV. 6-91)

INSTRUCTIONS

General: A permit must be issued prior to starting welding, cutting, or brazing, regardless of

GSA Service involved. All welding, cutting, or brazing shall adhere to the relevant OSHA

Standards (29 CFR 1910, or 29 CFR 1926). Every item on the form must be completed. The

lack of signatures or any item not completed voids the permit. If the work is performed for a

confined space entry task, a copy of this form is posted next to GSA form 3625, Permit for

Confined Space Entry. Both forms must be clearly posted outside the confined space. Prior

approval from the regional Safety Environmental Management Office is mandatory if the

permit is issued for a confined space entry task. Upon completion of the work, or when the

expected stop time is reached (which ever comes first), the completed permit is retu

rned to the

issuing authority for filling. The issuance of the permit in no way relieves a contractor of

responsibility for an accident resulting from negligence with the work.

1A - 1B Fill in the emergency name and telephone number in red (preferred).

4A - 4C Permit is not valid 30 minuted prior to the end of the schedule work shift.

5 Validation for permit.

7 Protective devices also included screens and barricades for the protection of

others.

8 Initial beside name to indicate knowledge and understanding of the form, its

intended purpose, an safety precautions per OSHA Standard 29 CFR 1910,

Subpart Q.

9 Initial besides name to indicate knowledge and understanding of the form and

duties of a fire watch per OSHA Standard 29 CFR 1910, Subpart Q. The fire

watch will not be the same person performing the work.

11 The pre-work inspection must be on the date of work before starting the

operation. The supervisor in charge of the GSA employee performing the work

or the Contracting Officer's representative conducts the inspection. The

inspector ensures all combustibles are removed, covered, or protected.

12 Approves by the facility manager or authorized representative.

13 Conduct checkup 30 minutes after completion of work. Inspection should

ensure the area is free of hazardous conditions.

Item No. Action