Hot Work Permit

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Permit Details

• Time and Date permit becomes active

  Date

• Time and Date permit will become deactive

  Date

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• Permit issued to

  Sign

• Description of the Hot Work to be undertaken

• Fire fighting equipment to be on hand as part of this activity

• Fire extinguisher

  Yes

  No

  N/A

• Fire hose reel

  Yes

  No

  N/A

• Water supply

  Yes

  No

  N/A

• Fire blanket

  Yes

  No

  N/A

• Other equipment to be at the ready for this activity

Control Measures

• Have combustible materials been removed and area made safe

  Yes

  No

  N/A

• Have tanks, vents and pipelines been blanked from the work area or made safe

  Yes

  No

  N/A

• Drains and Pits are covered or isolated

  Yes

  No

  N/A

• Is the area adequately ventilated

  Yes

  No

  N/A

• Have leaks from valves and pump glands, flanges and the like been controlled

  Yes

  No

  N/A

• Have pressure relief valves been vented to safe areas

  Yes

  No

  N/A

• Has contaminated ground been covered

  Yes

  No

  N/A

• Spark flash screens in place

  Yes

  No

  N/A

• Area isolated or barricaded off

  Yes

  No

  N/A

• Is the fire pump or fire brigade on standby

  Yes

  No

  N/A

• Fire equipment has been checked, laid out and is fit for purpose.

  Yes

  No

  N/A

• Will weather conditions potentially effect this task, if so what extra precautions will be enlisted

  Yes

  No

  N/A

• Other details

Fire watch if required

• Is the firewatch required

  Yes

  No

  N/A

• Has the firewatch been organised

  Yes

  No

  N/A

• Fire watch person

  Sign

Completion of Hot Work Inspection

• Time and Date post activity inspection undertaken

  Date

• Name of person undertaking the post activity inspection

• Signature of inspecting person for this hot work permit and declares safe for normal operation

  Sign

• Permit received by

  Sign

• Person in charge of location

  Sign

• Responsible officer

  Sign

• Add signature

  Sign

Permit Cancelation

• Notes or relevant details if required

• Time and Date permit terminated

  Date

• Staff member terminating this permit

  Sign