Hot Works - Permit to Work

• Conducted on

  Date

• Prepared by

• Location
  Address

• HOT WORKS PERMIT TO WORK NUMBER

• What works will be undertaken?

• Special Tools / Equipment to be Used

• Job Location / Plant Identification Number

• Is any other work currently being undertaken that may interact or affect this permit? (Quote Permit numbers where applicable)

This Permit is only Valid when all sections are complete. If you are in doubt or don't understand, then please ask. Remember, all accidents are preventable and it is people who get hurt and suffer pain. Please use this permit in the spirit intended to protect yourself and others. Please ensure that you sign this permit to work. DO NOT PROCEED WITH YOUR WORK UNTIL YOUR PERMIT HAS BEEN AUTHORISED BY THE RELEVANT MEMBER OF STAFF.

PRIMARY HAZARDS - Fire, Fumes, Electrical, Explosion, Gases & Smouldering / Smoke

Please answer the questions truthfully

• Are you Qualified / Trained to undertake this work?

  Yes

  No

  N/A

• Has the Fire Sprinkler System been left in service?

  Yes

  No

  N/A

• Are 2x Fire Extinguishers available at the work location? Are they the correct type for the equipment in the area?

  Yes

  No

  N/A

• Is a Fire Blanket Available for Clothing Fires?

  Yes

  No

  N/A

• Is there a means of sounding the site fire alarm in the vicinity of the works?

  Yes

  No

  N/A

• Have the Fire Alarm Sensors near the works being isolated / impaired to prevent accidental activation of the fire alarm?

  Yes

  No

  N/A

• Is the work area clear of combustible materials?

  Yes

  No

  N/A

• Are walls / floors (Including Gulleys / Combustible Voids) suitably protected by Fire Blankets?

  Yes

  No

  N/A

• Are the vessels / lines isolated (LOTO)/ Capped with Blinds and purged of flammable liquids?

  Yes

  No

  N/A

• Is the work area wetted out if required?

  Yes

  No

  N/A

• Is there a Fire Watch Trained person on standby with a Fire Extinguisher at all times when the works are in progress, and for 60 minutes after work is completed?

  Yes

  No

  N/A

• Is continual gas monitoring required?

  Yes

  No

  N/A

• Is intrinsically safe equipment required i.e. Non-Sparking CuBe Tools or ATEX Rated Electrical Equipment?

  Yes

  No

  N/A

• Are personnel wearing flame retardant overalls / boots and gloves?

  Yes

  No

  N/A

• Are personnel wearing eye protection / head protection if required?

  Yes

  No

  N/A

• Is atmosphere test required? If yes, complete section below.

  Yes

  No

  N/A

ATMOSPHERE TEST 1

• Insert Time of Atmosphere Test 1

  Date

• Oxygen %

• Oxygen %

  Pass

  Fail

  N/A

• Carbon Monoxide %

• Carbon Monoxide %

  Pass

  Fail

  N/A

• Combustible Hydrocarbons %

• Combustible Hydrocarbons %

  Pass

  Fail

  N/A

ATMOSPHERE TEST 2

• Insert Time of Atmosphere Test 2

  Date

• Oxygen %

• Oxygen %

  Pass

  Fail

  N/A

• Carbon Monoxide %

• Carbon Monoxide %

  Pass

  Fail

  N/A

• Combustible Hydrocarbons %

• Combustible Hydrocarbons %

  Pass

  Fail

  N/A

OTHER PRECAUTIONS REQUIRED

• Do any other precautions need to be put in place to allow the works to proceed safely?

• Is any other safety equipment required for the works to proceed safely?

• Person in Charge of Works

• Company

• Signature

  Sign

• Authorising Person

PERMIT EXPIRY DETAILS

• Permit Expires on

  Date

• Name of Person Undertaking Fire Watch

• Fire Watch Start Time

  Date

• Fire Watch Finish Time

  Date

Minimum Fire Watch period is 60 minutes after works are completed.

I confirm that the work has been completed, checked by myself, fire watch completed and the area left in a safe and tidy condition.

• Person in Charge (Print Name)

• Person in Charge (Signature)

  Sign

I have inspected the completed work, confirmed fire watch is completed and returned any isolated fire protective equipment (Alarms / Sprinklers) to its normal status. I hereby cancel this permit.

• Authorised Person (Print Name)

• Authorised Person (Signature)

  Sign

PERMIT CANCELLED

• Permit Cancelled

  Date