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| **HOT WORK PERMIT**             |   | **General Precautions**          |
|                                 |   |                                  |
| Permit Valid Only for Day       |   | Fire suppression system and      |
| Issued                          |   | extinguishers                    |
|                                 |   |                                  |
| Date: \_\_\_\_\_\_\_\_\_\_\_\_  |   | available and operable.          |
|                                 |   |                                  |
| Bldg.:\_\_\_\_\_\_\_\_\_\_\_\_  |   | Hot Work equipment operable &    |
|                                 |   | good repair.                     |
| F                               |   |                                  |
| loor:\_\_\_\_\_\_\_\_\_\_\_\_\_ |   | Smoke/Fire detectors in the      |
|                                 |   | immediate hot                    |
| Description of                  |   |                                  |
| Job:\_\_\_\                     |   | work area have been temporarily  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |   | disabled until                   |
|                                 |   |                                  |
| \_\_\_                          |   | work completed.                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |   |                                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |   | **Precautions within 35' of Hot  |
|                                 |   | Work**                           |
| \_\_\_                          |   |                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |   | Floor swept clean of             |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |   | combustibles.                    |
|                                 |   |                                  |
| Before signing this card the    |   | Flammable liquids removed,       |
| individual responsible for Hot  |   | combustibles, if not             |
| Work Safety should inspect the  |   |                                  |
| work area and check the         |   | removed, protected with welding  |
| precautions taken.              |   | drop cloths or                   |
|                                 |   |                                  |
| The precautions checked on the  |   | shields.                         |
| reverse of this card have been  |   |                                  |
| taken to prevent fire.          |   | Combustible flooring wet down,   |
| Permission is granted for this  |   | covered with                     |
| work.                           |   |                                  |
|                                 |   | damp sand, welding drop cloths   |
| Signed:\_\_\_\_\_\_\_\          |   | or shields.                      |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |   |                                  |
|                                 |   | All wall and floor openings      |
| Permit Expires                  |   | covered.                         |
|                                 |   |                                  |
| Date: \_\_\_\_\_\_\_\_\_\_      |   | Fire resistant tarpaulins        |
| Time:\_\_\_\_\_\_\_\_           |   | suspended beneath                |
|                                 |   |                                  |
| Time Job                        |   | work.                            |
| Start                           |   |                                  |
| ed:\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |   | **Precautions within 50' of Hot  |
|                                 |   | Work**                           |
| Time Job                        |   |                                  |
| Fini                            |   | Compressed gas cylinders moved   |
| shed:\_\_\_\_\_\_\_\_\_\_\_\_\_ |   | from area or                     |
|                                 |   |                                  |
| **Final Checkup**               |   | adequately protected.            |
|                                 |   |                                  |
| Work area and all adjacent      |   | **Work on Walls or Ceilings**    |
| areas to which sparks and heat  |   |                                  |
| have spread (such as floors     |   | Construction is noncombustible.  |
| above and below and on the      |   |                                  |
| opposite sides of walls) were   |   | Combustibles moved away from the |
| inspected for at least 30       |   | other side                       |
| minutes after the work was      |   |                                  |
| completed and found fire free.  |   | of the wall.                     |
|                                 |   |                                  |
| Signed:\_\_\_\_\_\_\_\_\        |   | **Work on Enclosed Equipment     |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |   | (Tanks, etc.)**                  |
|                                 |   |                                  |
| After signing, return permit to |   | Tanks, drums, or barrels have    |
| the facility individual         |   | been cleaned and                 |
| responsible for Hot Work        |   |                                  |
| Safety. Maintain in files for a |   | purged of flammables and toxics. |
| period of 3 years.              |   |                                  |
|                                 |   | Tank feeds are locked out and    |
| **\[FRONT SIDE\]**              |   | tank is vented.                  |
|                                 |   |                                  |
|                                 |   | **Fire Watch**                   |
|                                 |   |                                  |
|                                 |   | Fire watch provided during and   |
|                                 |   | for 30 minutes                   |
|                                 |   |                                  |
|                                 |   | after work.                      |
|                                 |   |                                  |
|                                 |   | Fire watch trained in use of     |
|                                 |   | fire suppressants                |
|                                 |   |                                  |
|                                 |   | and alarms.                      |
|                                 |   |                                  |
|                                 |   | \[**BACK SIDE\]**                |
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