Loss Prevention Manual

March 31, 2005

Pgina 1 de 1
Revisin: 2
Documento PP-F-40.01-01

HOT WORK PERMIT

DEPARTMENT:
AREA:
EQUIPMENT/MACHINERY:

COMPANY:

INITIATION DATE:
COMPLETION
DATE:
TIME:

WORK DESCRIPTION:
Work Environment:
* Free of combustible or flammable material .......................Yes
No
N/A
* The presence of flammable gases was analyzed..................Yes
No
N/A
* The wind direction was checked.................................... Yes
No
N/A
* Appropriate ventilation............................................... ..Yes
No
N/A
* A sufficient number of fire extinguishers is available.................Yes
No
N/A
Equipment/Machinery:
* Washed and free of combustible or flammable substances .....Yes
No
N/A
* Electrically blocked and labeled (lock-out/tag-out) ................. ..Yes
No
N/A
* Blocked and labeled engines and valves (lock-out/tag-out)Yes
No
N/A
Work Procedures:
* Fire Observer present since before the commencement of the work.....Yes No N/A
* Workers checked and are aware of all applicable procedures.Yes No N/A
* Potential hazards have been taken 20 m away from work area;
or have been covered with fire-resistant material..Yes No N/A
* Workers wear appropriate Personal Protective Equipment....... ........... Yes No N/A
* Hot work equipment was checked and found to be in proper
operating condition...................................................................... ..Yes No N/A
* Ground connections are properly installed.......................................Yes No N/A
* Workers are aware of the location of fire fighting equipment,
first-aid kit, telephones, radios and emergency frequencies.....
Yes No N/A
The personnel are suitably trained........................................... .......Yes No N/A
Observations:
I HAVE READ AND UNDERSTOOD THE PROCEDURES GOVERNING THE
PERFORMANCE OF HOT WORKS AND THE REQUIREMENTS OF THIS PERMIT
------------------------------------------------------------------------Worker
Fire Observer
Date
I HAVE MADE THE APPROPRIATE INSPECTIONS AND ASSURE THAT THE
INFORMATION CONTAINED IN THIS PERMIT IS TRUE
Supervisor

----------------------

Signature

---------------------

Date ---------

Superintendent/Head------------- Signature
----------------------Date -------------ONCE HOT WORK IS COMPLETED
The area where hot work was performed was inspected by the fire observer, using a fire
extinguisher, 30 minutes after such work was completed and no potential fire risk was identified.
Supervisor . Signature .. Date

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