Ardua Contracting Services Pty Ltd Hot Work Permit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Section A

• Select date

  Date

• Site

  Select Aldersyde Beverley Brookton Dale Mawson Mt Kokeby Quairading York Yoting Kondinin Bullfinch

  • Aldersyde
  • Beverley
  • Brookton
  • Dale
  • Mawson
  • Mt Kokeby
  • Quairading
  • York
  • Yoting
  • Kondinin
  • Bullfinch

• Description of work.

• Description of ground conditions where works are to be carried out.

  Select Bare Grassy Bitumen Concrete Gravel

  • Bare
  • Grassy
  • Bitumen
  • Concrete
  • Gravel

• Start time

  Date

• Finish time.

  Date

Section B Weather Conditions 2 reds do not complete works.

• Weather Risk Assessment

• Is there a machinery movement ban in the shire. If yes do not complete works.

  YES

  NO

• Temperature

  Select Hot 30+ deg Mild 20 to 30 deg Cool <20 deg

  • Hot 30+ deg
  • Mild 20 to 30 deg
  • Cool <20 deg

• Wind Levels

  Select Windy >15km Mild <15km Still

  • Windy >15km
  • Mild <15km
  • Still

• Are there flammable materials within 10m

  YES

  NO

Machinery Protection

• Machinery has been isolated and danger tags attached to main isolator.

  Yes

  No

  N/A

• Surrounding equipment has been isolated and airborne dust allowed to settle.

  Yes

  No

  N/A

• Any spouts or floor openings in the vicinity have been blocked to prevent hot materials falling through.

  Yes

  No

  N/A

• Has a suitable fire blanket been placed over any susceptible machinery.

  Yes

  No

  N/A

• If cutting in to an elevator or chute are the elevator buckets empty and the inside surfaces washed down.

  Yes

  No

  N/A

Preventing fire ignition and escape.

• What suitable fire fighting equipment is present

  Select Fire fighting unit Fire extinguisher Water bucket Water hose

  • Fire fighting unit
  • Fire extinguisher
  • Water bucket
  • Water hose

• Has someone been designated to stand as fire watch. This, CBH inducted, person will be on watch for accidental combustion.

  Yes

  No

  N/A

• Who from CBH Operations has been notified of the issue of this permit?

After Completion Of Works

• Has the work site been cleared of all debris and contaminated material removed?

  Yes

  No

  N/A

• Has the fire watch been in place for the period of one hour from completion of activities?

  Yes

  No

  N/A

• An inspection has been made of the work area and surrounding equipment and deemed to be safe with NO risk present.

  Safe

  At Risk

  N/A

• All blanking plates or fire blankets have been removed.

  Yes

  No

  N/A

• All isolations have been removed.

  Yes

  No

  N/A

• Company performing works?

• Spotter

  Sign

• Permit issued by.

  Sign