Work Permit - Hot Works

• Site conducted

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• Location
  Address

Part A - PRE COMMENCEMENT OF WORK

• This permit to work is issued for the following work.
  No work other than that detailed must be carried out.
  Part A is to be completed Prior to the commencement of any work
  Part B must be completed when all work has been completed

• Date and Time for Commencement of Work

  Date

• Date and Time for Work to be completed by

  Date

• Area/Plant to be worked on:

• Description of Work: (Specific Hazards)

Precautions

• Ensure hot work equipment is suitable for use and in good order
  Check location and means of raising alarm
  Ensure location of extinguishers/ hose reels
  Inspect nearby areas
  Remove any combustible material from work area
  Remove any flammable liquid containers from work area (whether full or empty)
  Provide suitable and adequate protections against sparks and hot particles
  Follow-up inspection (.......... hours and .......... mins later)

• Is work to be carried out when plant equipment or systems are in operation?

  Yes

  No

• Extra precautions to be taken if plant, equipment or systems are in operation:

Authorisation

• Name of authorized Ace Express staff member issuing permit:

  Sign

Receipt

• I hereby declare that no work other than that stated above will be carried out, and that all precautionary measures will be adhered to.

• Contractor Company Name

• Contractor Signature

  Sign

PART B - POST COMPLETION OF WORK

• I hereby confirm that the work(s) stated in Part A has / has not been completed. All equipment / tools have been removed, and the area has been cleaned / left in a safe condition.<br>

  Has

  Has Not

• Select date

  Date

• Contractor Company Name

• Contractor Signature

  Sign

Cancellation

• All copies of this permit to work are hereby cancelled.

• Select date

  Date

• Signature of authorized Ace Express Staff Member:

  Sign