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Instructions Required Precautions Checklist

Fire Safety Supervisor:

A. Verify all precautions listed at right

(or do not proceed with the work)

B. Complete and retain Part 1.

C. Issue Part 2 to Person doing job

AM AM

PM PM

AM

PM

Work on walls, ceilings or roofs

Construction is noncombustible and without

combustible covering or insulation.

Combustibles on other side of walls, ceilings

or roofs are moved away.

Available sprinklers, hose streams and

extinguishers are in service / operable

Hot Work Equipment is in good repair

Flammable liquids, dust, lint, and oily

deposits removed.

Floors swept clean.

BEFORE INITIATING HOT WORK :

ASK : CAN THIS JOB BE AVOIDED? IS THERE A SAFER WAY?

LOCATION / BUILDING AND FLOOR

Protect/shut down ducts and conveyors that

carry sparks to distant combustibles.

Remove other combustibles where possible.

Otherwise protect with fire-resistive tarpaulins

or metal sheet.

Fire-resistive tarpaulins beneath work.

All wall and floor openings covered.

Requirements within 10 m (35 ft) of work

Work on enclosed equipment

Pressurised vessels, piping, etc. removed

from service, isolated and vented.

Enclosed equipment cleaned.

Containers purged of flam. liquids / vap.

CONTRACTOR

Hot work being done by

HOT WORK PERMIT

This Hot Work Permit is required for any temporary operation involving open flames or producing heat and/or

sparks. This includes, but is not limited to: Brazing, Cutting, Grinding, Soldering, Torch applied Roofing andWelding.

PART1

EMPLOYEE

Extra fire extinguisher provided at workspot

Combustible f loors wet down, covered with

damp sand or fire-resistive sheets.JOB NUMBER

Explosive atmosphere in area eliminated.

Use as appropriate for your Facility.

PERMIT PERIOD NOT TO EXCEED ONE (1) SHIFT

NOTE: emergency notification on back of form.

SIGNED (Fire safety supervisor / operations supervisor)

TIME STARTED

DATE

PERMIT

EXPIRES

I hereby verify the above location has been

examined, the Precautions checked on the required

Precautions Checklist haven been taken to prevent

fire and Permission is authorized for this work.

NATURE OF JOB

NAME OF PERSON DOING HOT WORK

TIME FINISHED

DATE TIME

Fire watch is trained in use of equipment and

in sounding alarm.

Fire watch may be required in adjoining

areas, above and below.

Fire watch / hot work area monitoring

Fire watch will be provided during and for 60

minutes after work, including breaks.

Fire watch is supplied with suitable

extinguishers and a charged small hose.

Monitor Hot Work area for 2 hours after job is

completed.

Other precautions taken:

Signature of this document does not waive or reduce the responsibility in any way of the contractor

carr in out these works !

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#R

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#REF!

WARNING!

IN CASE OF EMERGENCY:

Hot Work in Progress!

At :

WARNING!

BE ALERT FOR FIRE!

Call :

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