Name of Project
SHBRH Project Coordinator
Name of Contractor Performing Work
24 Hour Contact Number
Select The Risk Level (NOTE: You must refer to the matrix included in the policy)
Note: NFPA 101-2000:18/184.108.40.206- all penetrations must be sealed with a fire rated sealer
Is this project creating any penetrations?
A "Hot Work Permit" will be required if the project is involving open flames or producing heat and/or sparks. This includes, but not limited to: brazing, cutting, grinding, soldering, torch-applies roofing and welding.
Does this project require a "Hot Work Permit"
Please list all sub-contractors (company name and phone number)
Please list the names of ALL personnel that will be onsite. Refer to the identification policy of MCMC
This permit must be completed prior to the start of the project. This permit will be posted at the entrances of the work site.