Smithsonian Institution Rev 11-24-2008 Page 1 of 3
HOT WORK PERMIT
1 SI Tracking #
The Following Section to be Completed by the General Contractor or Requestor
2 NAME OF BUILDING AND CONTACT NUMBER EMERGENCY PHONE #
Parent Building
Project Title
Permit Issued To Phone
Requested by Phone
The Following Section to be Completed by the General Contractor or Requestor
3 EXACT LOCATION OF WORK AREA ( Specific Area Name & Room # and/or Exterior Location)
4 TYPE OF HOT WORK CONTRACTOR AND/OR SI WORK GROUP & TYPE OF GENERAL WORK
Select Type of Work from Drop Downs. Select "blank" to write additional comments.
HOT WORK PERMIT IS ONLY GOOD FOR 24 HOURS FROM ISSUE DATE AND TIME. PERMIT MUST BE AUTHORIZED BY DESIGNATED
INDIVIDUAL PRIOR TO HOT WORK.
PERMIT START DATE
PERMIT EXPIRE DATE
The Following Section to be Completed by the Permit Authorizing Individual or Requestor
5 Additional Comments
The Following Section to be Completed by PAI within 24hours and Supervisor within 1 hour of hot work. PAI Supervisor
6 Required Precautions Checklist - The Following Precautions have been Taken Check ( X ) YES NO N/A YES NO N/A
a Portable fire fighting equipment readily available and nearest phone and fire alarm box identified
b All fire systems in service and operational / Fire System Impairment Permit Completed? (attach copy to HW Permit if applicable)
c Hot work equipment is in good repair and personnel protective equipment will be used during hot work
d Flammable liquids, dust, lint, and oil deposits are removed within 35 ft of operation (not specified). Floor area has been swept clean.
e Explosive atmospheres (conditions) in area eliminated
f Combustible floors wet down, covered with damp sand or fire resistant sheets intalled within 35 ft of operation (not specified).
g Combustibles have been removed where possible and/or items are protected with fire resistant tarps and/or shields
h All wall and floor openings are covered within 35 ft of operation (not specified) and fire resistant tarps will be used beneath work area.
i Construction is noncombustible or protected / Combustibles on the other side of wall have been moved where applicable
j Where danger exist to adjacent areas or rooms from heat, a second fire watch will be used in adjacent area
k Enclosed equipment has been cleaned of all combustibles
l Containers and/or vessels have been purged of flammable liquids and/or vapors
m Ample ventilation is available to remove smoke / vapor from the work area and will be discharged to a safe location
n All compressed gas cylinders have been moved to a safe location
o Chemical hazards have been evaluated (coating, paint, cleaners, fumes, etc.) and removed
The Following Section to be Completed by the Permit Authorizing Individual
7 WORK SUPERVISOR CHECK NOTIFICATIONS (AS APPROPRIATE) / ZONE MGR NOTIFY DIRECTOR & BLDG SAFETY COORDINATOR
BUILDING SECURITY CONTROL OPER NOTIFIED
SI OFMR
* SAFETY NOTIFIED USRO / HVAC SHOP NOTIFIED
BUILDING MANAGER NOTIFIED * OEDC PROJECT MANAGER / COTR NOTIFIED SED BLDG SYSTEM ENG (BAS) NOTIFIED
WMC (1560) NOTIFIED * ZONE PROJECT LIAISON NOTIFIED SED CTRL SAFETY/FIRE PUMP SHOP NOTIFIED
MUSEUM DIRECTOR NOTIFIED CRAFTS SHOP NOTIFIED NMZ CTRL SHOPS NOTIFIED
BUILDING SAFETY COORDINATOR NOTIFIED *
* REQUIRED COPIES
Smithsonian Institution Rev 4-8-2008 Page 2 of 3
HOT WORK PERMIT
SI Tracking #
EXACT LOCATION OF WORK AREA ( Specific Area Name & Room # and/or Exterior Location) START DATE:
The Following Section to be Completed by the Permit Authorizing Individual
8
SPECIAL PROCEDURES OR PERMITS REQUIRED Check ( X ) YES N/A
a LockOut / TagOut Required - Proper procedures will be used and noted in the LOTO Log
b Confined Space Permit Required - Permit Attached
c Fire System Impairment Permit Required - Permit Attached
d Atmosphere tested for flammable vapors. ( % LEL) Test Results Shown in %
The Following Section to be Completed by the General Contractor or Requestor and the Permit Authorizing Individual.
9
* I verify the above location has been examined, the precautions checked on the required precautions checklist have been taken to
prevent fire and permit permission is authorized for work.
PRINT NAME (Hot Work Supervisor) PRINT NAME (Permit Authorizing Individual, PAI)
SIGNATURE Inspection Date / Time SIGNATURE Inspection Date / Time
PRINT NAME (Hot Work Operator) PRINT NAME (All Fire Watch Personnel)
SIGNATURE Inspection Date / Time SIGNATURE Inspection Date / Time
HOT WORK MAY BEGIN AFTER IT HAS BEEN VERIFIED THAT ABOVE CONDITIONS HAVE BEEN MET, PERMIT SIGNED FOR APPROVAL AND POSTED AT HOT WORK
SITE. COPIES OF THIS PERMIT HAVE BEEN DISTRIBUTED TO OFFICE OF PROTECTION SERVICES (SECURITY MANAGER AND SECURITY CONTROL ROOM
OPERATOR), BUILDING MANAGER, AND SAFETY COORDINATOR.
Yes or N/A box must be checked for every item in section 6 before signing this permit.
The Following Section to be Completed by the Fire Watch after the completion of the Hot Work.
10 FIRE WATCH
FIRE WATCH IS TO REMAIN 30 MINUTES AFTER COMPLETION OF HOT WORK! RETURN THIS PERMIT TO THE PERMIT AUTHORIZING INDIVIDUAL (PAI) UPON
COMPLETION OF HOT WORK. THE PAI MUST RETURN THE ORIGINAL PERMIT TO THE BUILDING/FACILITY MANAGER FOR FINAL RECORD KEEPING PURPOSES.
WORK AGAINST A BARRIER OR IN A LOCATION WHERE HEAT OR HEATED MATERIAL CAN BE TRANSMITTED THROUGH A PARTITION REQUIRES A SECONDARY FIRE
WATCH ON THE OPPOSITE SIDE OF THE BARRIER OR PARTITION.
FIRE WATCH STAYED 30 MIN AFTER HOT WORK ONLY ONE FIRE WATCH REQUIRED
SUITABLE FIRE EXTINGUISHER WAS PROVIDED MORE THAN ONE FIRE WATCH REQUIRED
FIRE WATCH TRAINED ON USE OF FIRE EXTINGUISHERS FIRE WATCH TRAINED IN SOUNDING THE FIRE ALARM
Initial
The Following Section to be Completed by the Permit Authorizing Individual after the completion of the Hot Work.
11
PAI's Signature & Additional Comments (Prior to turning in Permit to Building Management)
NOTIFIED SECURITY CONTROL ROOM OPERATOR (WORK COMPLETED)NOTIFIED TENANT / DEPT HEAD (WORK COMPLETED)
INSPECTED AREA AFTER HOT WORK (BACK TO NORMAL) PROPER PROCEDURES & PPE WERE USED (NO WORK STOPPAGE)
Print ( First, Last Name)(Title) Signature Date
Rev 4-8-2008 Page 3 of 3
HOT WORK PERMIT FORM
GENERAL INSTRUCTIONS
Summary:
The Hot Work Permit Form is to be used for conducting hot work outside of designated (fixed) hot work areas, meeting all applicable fire protection
regulations. The supervisor is responsible for the hot work being performed. He / she is responsible for requesting a permit prior to work. He / she will ensure
that all staff working in the area are trained and have read SI Safety Manual, Chapter 14 – Hot Work Management and Permit System. The Hot Work
Supervisor will ensure that a Fire Watch is present during work and remains for 30 minutes after hot work is completed. The Permit Authorizing Individual
(PAI) shall inspect the hot work area prior to granting a permit. The PAI will verify and sign off on the permit. The permit is void unless copies of the permit
are posted in the area and provided to Security Control Room Operator, Building Management and Safety Coordinator. The Hot Work Area Supervisor will
return the original hot work permit to the PAI on the next work day.
Purpose:
This permit is to be used for hot work and ensures that work is within all applicable fire protection regulations and well communicated. Reference: SI Safety
Manual Chapter 14 – Hot Work Management and Permit System.
Instructions:
1) SI Tracking Number– Enter the appropriate control number. The OFMR group will use an SWO for the tracking number. The
tracking number will be used for a reference to work which allows us to pull historical records for labor and material cost. All
individuals in the Office of Facility Maintenance & Reliability (OFMR) working on this permit should use the same number.
2) Name of Building – select from the drop down list the location of work. If unable to find a proper location use the blank and type in the building name.
Project Title – Show the name of the project if applicable
Permit Issued To & Requested By – Provide first, last name (print) and phone number with area code ( xxx xxx-xxxx )
Location – Identify the exact location
Provide an emergency phone number ( xxx xxx-xxxx ).
3) Exact Location of Work Area – provide additional information for location.
4) Type of Hot Work – Select from drop down. Contractor and/or SI Work Group or Type of General Work pick from drop down.
Permit Start Date and Time / Permit Expire Date and Time – Select from drop downs.
The type of hotwork dictates the minimum acceptable distances in section 6d, f, and h. These distances are automatically filled in based on the type of hot
work selected. The following table illustrates the appropriate distances.
Type of Hot Work Required Safe
Distance
Brazing 15ft
Cutting 35ft
Grinding 35ft
Soldering 10ft
Welding 35ft
5) Additional Comments – Use this block to provide more specific information.
6) Required Precautions Checklist – The Permit Authorizing Individual (PAI) and Hot Work Supervisor shall use the list and check those that are
appropriate ( yes, no or n/a). The permit is NOT to be signed unless all items listed are marked as either "yes" or "n/a".
7) Notification Section: Check departments and shops notified. The work coordinator will provide copies provided to Building Security Control Operator,
Building Management, and Safety Coordinator are mandatory for all work. Copies of this permit must be given to these shops prior to any work other
than extreme emergencies.
8) Special Requirements and Permits – Check “YES” or “N/A” to indicate whether or not LockOut & TagOut, Confined Space and / or Fire System
Impairment Permits are required. For conserns or questions about atmospheres containing flammible vapors contact the Office of Safety, Health and
Eviromental Managment.
9) Permit Authorizing Individual (PAI), Hot Work Supervisor, Operator and Fire Watch Personnel will provide first, last name (print), signature, date and
time. The Project Manager and / or Contracting Officer Technical Representative (COTR) will provide the same if requesting and are responsible for the
work being performed by contractor.
10) Requirements for Fire Watch, Hot Work Area Monitoring – The Fire Watch will answer and initial off this section as a monitoring tool and to summarize
the work prior to the PAI turning the permit back into Building Management. Work agianst a barrier or in a location where heat or heated material can be
transmitted through a partition requires a secondary fire watch.
11) The Permit Authorizing Individual (PAI) will print last, first name, sign and date to verify that the hot work is complete, the site is back to normal, proper
procedures were followed and all notifications were made. This form should be returned to the Building Managment Office upon completion.
The Permit Authorizing Individual (PAI) will print last, first name, sign and date to verify that the hot work is complete, the site is back to normal, proper
procedures were followed and all notifications were made. This form should be returned to the Building Managment Office upon completion.
