Title Page
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Reference
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Site conducted
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Conducted on
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Prepared by
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Location
Untitled Page
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Area of access:
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Date / time requested:
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Daily Issue Only
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Type of Hot Work to be carried out:
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□ Burning or air gouging □ Arc Welding
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□ Gas Welding □ Grinding
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□ Soldering □ Other (explain overleaf)
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4. Valid From:
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(time/date)
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Type of Hot Work to be carried out:
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□ Burning or air gouging □ Arc Welding
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□ Gas Welding □ Grinding
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□ Soldering □ Other (explain overleaf)
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5. Valid To:
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(time/date)
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6. Company / Contractor:
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7. Contractor Supervisor:
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8. Grwp Cynefin:
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9. No of Personnel:
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10. Additional Safety Precautions: (add comments overleaf)
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A) Risk Assessments and Method Statements Reviewed?
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B) Extra Fire Extinguishers required?
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C) Fire blanket or damping down required?
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D) Fire watch required?
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E) Impairment or isolation of fire detection system required?
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F) Impairment or isolation of fire suppression system required?
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G) Do the insurers need to be informed?
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H) Is a fire emergency plan in place and is everyone trained in it?
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I) Personal Protective Equipment requirements identified (if more than standard type)
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J) Combustible material, flammable liquids, gases) removed / protected around the work area?
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K) have adequate screens been erected to minimize danger of weld flash?
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11. Approval of Permit to Work
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I am satisfied that the safe working arrangements are in place in accordance with the Risk Assessment and Method Statement presented and that all persons involved in the task have been informed
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Signed on behalf of Grwp Cynefin
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(Issuing Authority)
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Document Number of Risk Assessment
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Document Number of Method Statement
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12. Electrical / Mechanical Equipment
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All relevant safety isolations in place with CAUTION NOTICE displayed at points of isolation
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Please list isolations:-
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Signed
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(Performing Authority)
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13. Acceptance of Permit to Work
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I/we* have read and understood the above precautions and will observe them. I understand the site emergency plan
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All equipment is certified to the appropriate standard for these works
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Signed
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(Performing Authority)
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14. Completion of Hot Work Permit
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I confirm that all areas in and around where heat, fire, sparks may have spread were thoroughly inspected on completion of the Hot Work and have been thoroughly inspected 30 minutes after completion and were free from fire or smouldering materials and have been left in a safe condition
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(Performing Authority) Signed
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Signed
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(Grwp Cynefin)
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15. Renewal of Permit to Work (same day only)
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(Grwp Cynefin)
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Approved until
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Signed
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Signed
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Approved until
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(Performing Authority)
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Section 10
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Additional Safety Precaution Comments
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The fire suppression system shall be isolated at the main panel and covers placed over the canisters
