Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Job Number
- 317901
- 317906
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Is this a daily operation?
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Start date
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End date
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Work Area
- Segment 1
- Segment 6
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Supervisor
- Jim Baxter (760) 600-1543
- Barney Stenlake (951) 830-0324
- Mike Strachota (760) 497-4505
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Description of work
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Type of equipment that will be used
- Oxy/Acetylene
- Air Arc/ Goug in
- Electric Arc
- Other
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Please describe the other pieces of equipment being used
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Fire hazards present
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Fall hazards
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Other hazards present
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Controls Implemented
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Is a work area a confined space?
Additional Welders
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Add signature
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License Review
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Expiration date
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Equipment authorized to use
Workers / Fire Watch
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Add signature
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Start time
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Stop time
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Permit Status
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Reason if rejected
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Signature of authorized hot work supervisor
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Date
