Permit to Work - Hot Works

• Site Name

• Contractor carrying out the work

• Supervised by

• Area to be worked in

• Work to be carried out

• Plant/Equipment to be used

• Area cleared of all loose combustible material?

  Yes

  No

  N/A

• Opposite side of walls, partitions or ceilings cleared if risk of fire by conducted heat is present?

  Yes

  No

  N/A

• Suitable extinguishers of appropriate type at hand. Specify type:

  Yes

  No

  N/A

• Specify type

• Exposed wooden flooring or other combustible fixtures protected?

  Yes

  No

  N/A

• Is a fire watch required whilst works are in progress?

  Yes

  No

  N/A

• When welding, cutting or grinding the work area is suitably screened?

  Yes

  No

  N/A

• Will the work area require to be dampened down / sprayed with water during works?

  Yes

  No

  N/A

• Are gas cylinders secured in a vertical position and fitted with regulator & Flashback arrestor?

  Yes

  No

  N/A

• Are gas cylinders in good condition with all dials etc functioning?

  Yes

  No

  N/A

• Will periodic checks be carried out for the hour after hot works are complete?

  Yes

  No

  N/A

• Will a final check be carried out of the area after one hour?

  Yes

  No

  N/A

• Specify conditions for Tar boilers to be placed at ground level or in a position convenient for works.

• Is a non-combustible heat insulated base provided for the Tar boiler?

  Yes

  No

  N/A

• Specify the type of fire extinguisher at hand:

• Gas cylinders will be sited at least 3m from the burner?

  Yes

  No

  N/A

• Is the boiler sited where spillage can be easily controlled?

  Yes

  No

  N/A

• A lit tar boiler will never be left unattended?

  Yes

  No

  N/A

• If accessible by the public, are flammable materials removed from the location before signing off on the permit?

  Yes

  No

  N/A

• Work to start:

  Date

• Work to finish:

  Date

• Time limit:

  Date

AUTHORISATION

• I am satisfied that it is safe to do the work stated, provided that the above instructions are carried out (Midwest Manager Print Name)

• Midwest Manager Signature

  Sign

• I am fully aware of and understand the requirements stated on this permit (Operative Print Name)

• Operative (Operative Signature)

  Sign

• Date

  Date

WORKS COMPLETED AND AREA SAFE

• Midwest Manager Print Name

• Midwest Manager Signature

  Sign