Hot Works Permit

• Site conducted

  Select

• Permit Number:

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• Work Request No.:

• Associated PTW No.:

• Work specified in the Permit is conditional on all contractors having read, understood and signed the Integral Health & Safety policy.

Who is carrying out the works?

• Company name:

• Competent person in charge:

• Other personnel engaged in the works:

When:

• From:

  Date

• Until:

  Date

Task

• Where are the works to be carried out?

• Description of Works

• Why are the works taking place?

• Comments / Special Conditions

Mandatory Safety Requirements:

• Immediate and adjacent locations checked and combustibles removed or protected?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Location screened and protected, roped off and warning notices displayed before commencement of work?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Fire doors closed and drains and sewers within 25m sealed during hot works?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Local exhaust ventilation available?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Services associated with the work isolated or protected, including fire detection and fire protection systems?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Valves (designate) padlocked off, open-ended pipes and vessels sealed, spades fitted and local electrical circuits isolated?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Equipment earthed against static electricity?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Adequate fire fighting equipment has been inspected and is available to personnel trained in its use?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• A trained person will provide a continuous and vigilant Fire watch during the hot work and for at least one hour afterwards?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Personnel familiarised with the alarm point, means of escape and emergency procedures?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• PPE available and worn?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Building Fire Officer notified?

  Yes

  No

  N/A

• Permit not to be issued until checks are in place.

• Approved By:

  Sign

• Date:

  Date

• Authorisation: I confirm that I have personally checked that the control measures above are in place and consider it safe to carry out this work.

• Issued By:

• Signature:

  Sign

• Date:

  Date

• Acceptance: I accept responsibility for the work and personnel stated and agree to implement safe working procedures. I understand the hazards of this work and the precautions to be taken. These have been fully explained to the operatives carrying out this work and I consider them to be adequately trained and competent. Work will only be undertaken on the job / equipment specified. I will return my copy of this permit to the authorised person when this work has been safely completed. In the event of an emergency I will cease the work safely and comply with the Site emergency procedures. Work will only recommence when a new risk assessment has been done and a new permit issued.

• Accepted By:

• Signature:

• Date

Clearence

• Clearance: I confirm that personnel and equipment have been withdrawn. The work *has / *has not been completed and uncompleted work will not restart until a new Permit is issued. (*Delete as applicable). The location has been restored to a safe and orderly condition. I have returned my copy of this Permit to the authorised person.

• Returned By

• Signature:

• Date:

• Closure: I accept that the work has been safely completed. This permit is closed and invalid.

• Closed By:

• Signature

  Sign

• Date:

  Date