FSA HOT WORKS PERMIT FORM (TRAINING)

• Conducted on

  Date

• Prepared by

  Sign

• Location

• Work Location

• Purpose/Type of Work

• Start Time {in 24 hour time}

• Expected Duration {minuets}

• Department/Contracting Company

• Does this Permit combine with any other permits? Associated Doc. No. (JHA SWP, RA etc)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Associated Doc. No. (JHA SWP, RA etc)

• Have assessed the hazard controls in place for this job and it is consistent with the risk assessment requirement

  Yes

  No

  N/A

Associated permits

• Isolation {permit number in notes}

  Yes

  No

  N/A

• Confined space {permit number in notes}

  Yes

  No

  N/A

• Working with Heights {permit number in notes}

  Yes

  No

  N/A

• Dig {permit number in notes}

  Yes

  No

  N/A

• Other (provide details in notes)

  Yes

  No

  N/A

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• TYPE OF HOT WORK

  Select Grinding Mig Welding Arc welding Tig welding Oxy acetylene work Bolt cutting use of combustion engines Other { details in notes}

  • Grinding
  • Mig Welding
  • Arc welding
  • Tig welding
  • Oxy acetylene work
  • Bolt cutting
  • use of combustion engines
  • Other { details in notes}

• Area has been assessed for flammable hazards

  Yes

  No

  N/A

• Area is been inspected and cleared of flammable hazards with in <15 {details in notes}

  Yes

  No

  N/A

• Area is been inspected and cleared of flammable hazards with in 15> {details in notes}

  Yes

  No

  N/A

• Fire suppression equipment at site or close to area

  Yes

  No

  N/A

• Fire suppression equipment

  Select CO2 FEX Dry power FEX Water FEX Foam FEX Fire blanket Hose real

  • CO2 FEX
  • Dry power FEX
  • Water FEX
  • Foam FEX
  • Fire blanket
  • Hose real

• Additional comment

As the issuing person, I authorize the entry to this Confined Space subject to the conditions and precautions of the risk assessment and as indicated on this Permit.

• Permit issuer

  Sign

• Date of permit issue

  Date

As the Entry Permit Holder I accept this Permit and agree to be bound by the conditions above, the associated procedures, and accept the responsibility as the person directly in charge of the work in the confined space/s nominated

• Permit holder

  Sign

• Date of permit issue

  Date

Work party

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• Work party member

  Sign

• Time and date

  Date

• All work associated with this permit has been

  completed

  Cancelled

  Suspended

• The work area and adjacent areas have been inspected after completion & all hazards have been made safe

  Yes

  No

  N/A

• The work area and adjacent areas have been inspected for the duration of the fire watch period

  Yes

  No

  N/A

• Additional comment:

Issuing person

• Name of permit issuer

• Signature

  Sign

• Date of permit closure

  Date

Entry Permit Holder

• Name of permit holder

• Signature

  Sign

• Date of permit closure

  Date