Title Page

  • Document Number

  • Site conducted

  • Conducted on

  • Prepared by

Permit to complete Hot Works

  • Employee/s completing the hot works

  • Work Location:

  • Description of work to be completed:


  • If fire occurs, call "000"

  • Is Fire Watch required?

  • Engage person to stand on Fire Watch

  • Fire Fighting Equipment on hand?

  • Special Precautions:


  • The above work is authorised by the responsible person to proceed subject to the following action being taken prior to the hot work commencing. Each item is to be checked by the responsible person

  • Name of responsible person


  • The following checks have been made: (Note: all questions are to be answered)

The following checks have been made: (Note: all questions are to be answered)

  • Has a Hot Work Risk Assessment been done?

  • Have drains, pits and depressions been checked, isolated and sealed?

  • Have combustible materials been removed from the work area or made safe (eg. within 10m of hot work)?

  • Have tanks, valves, vents, pipelines been blanked off or isolated?

  • Is ventilation adequate?

  • Are spark / flash screens in place?

  • Are doorways and other area covered to prevent transmission of sparks?

  • Has the fire equipment been checked and laid out?

  • Covers suspended beneath work to collect sparks?

  • Is the wind direction satisfactory for hot work to be done?

  • Has product movement been stopped in the area of hot work?

  • Has the site of hot work been isolated/roped off?

  • PPE available and in good repair?

  • Are the correct flashback arresters fitted?

  • Is the last test date for all flashback arresters within 12 months?

  • Other?

  • ATMOSPHERE TESTING (Confined Space)


  • Date & Time of Test:

  • Results of tests % L.E.L:

  • Is Hot Work safe to proceed?

  • Tested By:

  • Tested By:


  • The work area and all adjacent areas where sparks may have spread have been inspected for at least 60 minutes after the work was completed and no fire conditions were noted

  • Date & Time:

  • Signed:

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