Permit No.
HOT WORK PERMIT
Instructions
1. Complete precautions checklist at right
2. Complete this form and retain part 1
3. Issue part 3 to competent person performing the hot works.
Permit information
Hot work done by:
Employee
Contractor
Location
/Building & Floor
Reason for Job
PPE Required:
Wielders hood with appropriate lenses
Wielders gloves
Lather jacket/Clothing
Head protection
Hearing protection
Respirator type/Cartridge
Others: ________________________
Hot work Performer
Name:
Signature:
I verify the above information has been examined, the precautions checked on the required
precautions checklist have been taken to prevent fire and permission is authorized for this work.
Hot work Supervisor approval
Name:
Signature:
Date:
Permit dates:
Permit activated Date: Time:
Permit expires Date: Time:
Date and time work completed Date: Time:
Final fire watch check-up Date: Time:
Fire Watch inspector signature (Below)
Signature: _____________
Required precautions checklist
Sprinkler protection in service (if present) and Hot work on walls, ceilings or roofs
hose and extinguishers available Construction is non-combustible and without
Hot work equipment is in good working order combustible covering or insulation
Requirements within 35 ft. of hot work Combustible material on other side of walls, ceilings or
Flammable liquid, dust, lint and oily deposits roofs is moved away
removed and floor swept clean
Explosive atmosphere in area eliminated (hot Hot work on enclosed equipment (i.e., welding on the
work is not to be conducted in a classified outside of tanks)
area unless made safe) Enclosed equipment cleaned of all combustible material
Nearby activities evaluated for conditions that Containers purged of flammable liquid/vapor
could be affected by hot work Pressurized vessels, piping and equipment removed from
Path of likely sparks evaluated service, isolated and vented
Combustible floors wet down, covered with Hot work inside of enclosed spaces (i.e., inside of tanks)
damp sand or fire-resistive sheets Adequate ventilation provided
Remove other combustible material where Atmosphere checked with gas detector per confined
possible. Otherwise, protect with approved space pr
welding pads, blankets and curtains or metal Area purged of any flammable or toxic vapours
shields Other permits completed as required: Lock-out/tag-out,
All wall and floor openings covered working live electrical work
Fire resistive covers and metal shields Hot work/Fire Safety Notifications
provided as needed Location of nearest fire alarm known
Protect or shut down ducts and conveyors that If no alarm present, what method will be used to raise the
might carry sparks to distant combustible ala other precautions area below)
material Escape routes maintained and known by personnel
An appropriate fire extinguisher is located in Fire Watch/Hot work area monitoring
the hot work area Fire watch will be provided for a minimum of 60 minutes
after ceased.
Fire watch is provided with suitable extinguishers
Fire watch trained in use of equipment and in sounding
alarm
Other Precautions/Special Instructions:
___________________________________________
__
