Permit - Hot Work

• Hot Work Permit

• Permit No:

DESCRIPTION OF THE WORK

• Work Location:

• Purpose / Type of Work:

• Permit Expires:

• Select date

  Date

• Department / Contracting Company:

REQUIRED PRECAUTION CHECKLIST

• For work likely to produce a source of ignition, including welding, gas cutting, blast cleaning and the use do sparking producing tools or portable equipment, or other determined sources of ignition

• Are persons entering and working in the hot work area trained and competent

• Do persons have a current risk assessment for the hot work area and the work to be done

• Other permits required

  Yes

  No
Other Permits

• Permit Type

  Confined Space Entry

  Group Isolation

  Working at Heights

• Permit No.

Task Details

• Task

• Location

• Add location
  Address

• Start Date & Time

  Date

• Finish Date & Time

  Date

Risk Controls

• Portable fire extinguisher available

  Yes

  No

• Running hose water required

  Yes

  No

• Fixed fire suppression systems operational

  Yes

  No

  N/A

• Combustible materials removed from 15 m radius

  Yes

  No

  N/A

• Shielding around combustible materials where clearance is not possible

  Yes

  No

• Barricading around job site required

  Yes

  No

  N/A

• Phone or 2-way radio required

  Yes

  No

• Emergency services advised

  Yes

  No

• Fire Authority or Council authorisation in place

  Yes

  No

  N/A

• Area below work area cleared

  Yes

  No

• Hot work signs required

  Yes

  No

• Interaction with other works considered

  Yes

  No

• Additional protection for rubber/combustible lining considered

  Yes

  No

  N/A

Special Conditions

Fire Watch

• Is a Fire Watch required

  Yes

  No
Fire Watch

• Fire Watch name

• Fire Watch signature

  Sign

• Fire Watch Date & Time

  Date

• Is a Post Fire Watch required (min of 30 mins to 2 hours)

  Yes

  No

  N/A
Post Fire Watch

• Post Fire Watch Name

• Post Fire Watch signature

  Sign

• Post Fire Watch START Time & Date

  Date

• Post Fire Watch END Time & Date

  Date

• Is a flammable gas test required

  Yes

  No

• Gas Tester name

• Gas Tester signature

  Sign

• Parameter

• Parameter result

• Time & Date of Test

  Date

Responsible Person

• I accept this permit, agree to be bound by the conditions above and the associated procedures and accept the responsibility as the person directly in charge of the work in hot work area nominated

• Responsible Person Name:

• Acceptor signature

  Sign

• Date & Time

  Date

Part B (Permit Issue to complete)

Authorised Person (Permit Issuer)

• I have inspected the work area where the hot work is to be conducted and satisfied the risk controls are place . I authorise the entry to this hot work area subject to the conditions and risk controls on the risk assessment and as stated on this permit

• Permit Issuer

  John Bean

  Andrew Nelson

  Zoe Kosmadopoulos

  Paul Gentles

  Dennis Kluge

• Permit Issuer signature

  Sign

• Issue Date & Time

  Date

• Is hot work being conducted in a hazardous area. Hazardous areas include any area that has rubber lined vessels or spirals.<br><br>Additional sign-off by the Project Manager or Site Manager is required

  Yes

  No

• Site Manager

• Site Manager signature

  Sign

• Site Manager Date & Time

  Date

Transfer

• Required if Permit Issuer leaves site prior to cancellation of permit. I have inspected the workplace where the hot work is being performed and satisfied the risk controls identified in the risk assessment and this permit are in place

Transfer name

• Permit Issuer

  John Bean

  Andrew Nelson

  Zoe Kosmadopoulos

  Paul Gentles

  Dennis Kluge

• Permit Issuer signature

  Sign

• Transfer Date & Time:

  Date

Section D

Cancellation (Permit Issuer to complete)

• All work associated with this permit has been completed. The work area and adjacent areas have been inspected for the duration of fire watch and post fire watch monitoring as stated in this permit. The work area has been cleared of any any debris and equipment is now ready to return to service. This permit is now relinquished.

• Permit Issuer Name

  John Bean

  Andrew Nelson

  Zoe Kosmadopoulos

  Paul Gentles

  Dennis Kluge

• Permit Issuer signature

  Sign

• Cancellation Time & Date:

  Date