Hot Work Permit

• Document Number

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

  Select

• Employee/s completing the hot works

  Select

• Work Location:

• Description of work to be completed:

EMERGENCY INFORMATION & EQUIPMENT

• If fire occurs, call "000"

• Is Fire Watch required?

  Yes

  No

  N/A

• Engage person to stand on Fire Watch

  Select

• Fire Fighting Equipment on hand?

  Select Fire Extinguisher Hose Reel Fire Blanket Water Truck Other

  • Fire Extinguisher
  • Hose Reel
  • Fire Blanket
  • Water Truck
  • Other

• Special Precautions:

AUTHORISED

• 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

  Yes

  No

  N/A

• Name of responsible person

EXPOSURE TO HAZARDS

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

  Yes

  No

  N/A

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

• Has a Hot Work Risk Assessment been done?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is ventilation adequate?

  Yes

  No

  N/A

• Are spark / flash screens in place?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has the fire equipment been checked and laid out?

  Yes

  No

  N/A

• Covers suspended beneath work to collect sparks?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• PPE available and in good repair?

  Yes

  No

  N/A

• Are the correct flashback arresters fitted?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Other?

• ATMOSPHERE TESTING (Confined Space)

  Yes

  No

  N/A

ATMOSPHERE TESTING (Confined Space)

• Date & Time of Test:

  Date

• Results of tests % L.E.L:

• Is Hot Work safe to proceed?

  Yes

  No

  N/A

• Tested By:

• Tested By:

WORK COMPLETED AND AREA SAFE

• 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

  Yes

  No

  N/A

• Date & Time:

  Date

• Signed:

  Sign