Hot Work Permit to Work Template

• This Hot Work Permit is required for any operation involving open flames or producing heat and/or sparks. This includes, but is not limited to, Brazing, Cutting, Grinding, Soldering, Thawing Pipe, Torch-Applied Roofing, and Welding.

• Permit No.

• Site Location
  Address

• Conducted on

  Date

• Prepared by

• Nature of Job/Object

Required Precautions Checklist

• Available sprinklers in normal automatic mode and valve open.

  ✔

  ✖

  N/A

• Hot Work equipment in good repair.

  ✔

  ✖

  N/A

• Assess 35 ft radial “sphere” of work for potential fire hazards:

• Floors, work level and below, cleaned or protected.

  ✔

  ✖

  N/A

• All other combustibles removed or shielded from sparks.

  ✔

  ✖

  N/A

• Clean horizontal surfaces (e.g. building structures, equipment, ducts, cable trays, etc.) above and below where possible.

  ✔

  ✖

  N/A

• Remove flammable liquids, dust, lint, combustible waste, oil deposits, etc., where possible.

  ✔

  ✖

  N/A

• If removal/cleaning is impractical, protect with fire-retardant covers, or shield with fire-retardant guards and/or curtains.

  ✔

  ✖

  N/A

• Transmission or conveying of sparks to adjacent areas eliminated or protected.

  ✔

  ✖

  N/A

• Tightly cover wall/floor openings with fire-retardant material.

  ✔

  ✖

  N/A

• Where openings cannot be sealed, suspend fire-retardant tarpaulins to help protect areas beneath.

  ✔

  ✖

  N/A

• Isolate or shut down fans and conveyors to prevent the capturing and conveying sparks to other areas.

  ✔

  ✖

  N/A

• Explosive atmosphere eliminated or potential not present.

  ✔

  ✖

  N/A

• Work on walls, ceilings or enclosed equipment:

• Construction materials verified as noncombustible and without combustible covering or insulation.

  ✔

  ✖

  N/A

• Combustibles on another side of walls relocated or protected.

  ✔

  ✖

  N/A

• Enclosed equipment cleaned and protected from all combustibles.

  ✔

  ✖

  N/A

• Containers purged of flammable liquids/vapors.

  ✔

  ✖

  N/A

• Fire watch/hot work area monitoring requirements:

• Continuous fire watch provided during and for at least 30 minutes after hot work, including all breaks.

  ✔

  ✖

  N/A

• Fire watch supplied with suitable extinguishers/hoses.

  ✔

  ✖

  N/A

• Fire watch trained in the use of fire equipment and sounding alarm.

  ✔

  ✖

  N/A

• Area to be monitored hourly for a minimum 6 hours after job is completed, or longer if required.

  ✔

  ✖

  N/A

• Fire watch provided for adjoining areas, above, or below.

  ✔

  ✖

  N/A

• Confined Space or Lock-Out-Tag-Out required/used.

  ✔

  ✖

  N/A

• Area smoke or heat detection disabled to eliminate false trip.

  ✔

  ✖

  N/A

Completion

• Full Name and Signature of Permit-Authorizing Personnel

  Sign

• Click + to add names of persons doing the hot work

Employee

• Full Name and Signature of Person doing the hot work

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