Read Hot Work Permit text version

Hot Work Permit Form

Section 1 ­ LOCATION DETAILS

Site Location: Date: / / Permit No.:

What hot work does this permit cover? Where is the hot work to be carried out? What equipment is to be used? Has a Hot Work Risk Assessment / Confined Space Risk Assessment (if relevant) been conducted? List the fire fighting equipment to be laid out at the worksite: YES (Please Attach) NO

Section 2 ­ EXPOSURE TO HAZARDS

The following checks have been made: (Note: all questions are to be answered). Have drains, pits and depressions been checked, isolated and sealed? Have combustible materials been removed from the work area or made safe? Have tanks, valves, vents and pipelines been blanked off or effectively isolated? Is ventilation adequate? Are spark/flash screens in place? Have leaks from valves/pump glands, flanges etc been controlled? Have pressure relief valves been vented to safe areas? Has contaminated ground been covered? Has the fire equipment been checked and laid out? Is the fire pump or fire brigade on stand-by if required? Is a fire watch required and organized? Is the wind direction satisfactory for hot work to be done? Has product movement been stopped in the area of hot work? Has the site of hot work been isolated/roped off? Other? YES NO N/A

COMMENTS

F-3040-060-K

Issue Date November 2009

Hot Work Permit Form

Section 3 ­ GAS TESTING

Equipment Make/Model: Serial No.: Date of Test: Results of tests % L.E.L.: Is Hot Work safe to proceed? Comments: YES NO Tested by: / / Date of last equipment test: Time of Test: / / / AM/PM

Section 4 ­ VALIDATION

The following conditions/ precautions being observed: This permit is valid from: to: Name of contractor performing the work: Order or Contract No.:

(Print Name) (Signature)

: :

AM/PM AM/PM

on on

/ /

/ /

(Print Name)

(Signature)

Permit Received By:

(Print Name) (Signature)

Person in Charge of Location:

(Print Name) (Signature)

Responsible Officer:

(Print Name) (Signature)

Section 5 ­ RETURN OF PERMIT

By: To: At:

This worksite has been inspected by me at the expiry/cancellation of the HOT WORK PERMIT and declared SAFE for normal operations to resume. Responsible Officer Name:

Responsible Officer Signature:

F-3040-060-K

Issue Date November 2009

Information

Hot Work Permit

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