Northwest Shoals Hot Work Permit

Job Date______________ Shift____________________________

Start Time_____________ Estimated Completion Time_____________

Name of Applicant _______________________ Company___________________________

Location/Description of Work ____________________________________________________

1.__________ (Yes or No) Are combustible materials in building closer than 35 feet to the point
of operation?

2.__________ (Yes or No) Are combustibles more than 35 feet away but would be easily ignited
by sparks?

3.__________ (Yes or No) Are wall or floor openings within a 35 foot radius exposing
combustible material in adjacent areas, including concealed spaces in floors or walls?

4.__________ (Yes or No) Does the work necessitate disabling a fire detection, suppression, or
alarm system component?

5.__________ (Yes or No) Is there any fire hazards that can’t be moved or protected by
appropriate guards?

Yes to any of the above indicates that a qualified fire watch is required.

Is a Fire Watch Required?__________ (Yes or No)

6.__________ (Yes or No) Have the fire extinguishers in the area been checked serviceability?
What type fire extinguishers are being used?_________________

7.__________ (Yes or No) Has person completing this Hot work Permit been trained in safe
operation of welding and cutting equipment and passed all 4 initial safety test before being
allowed to participate in shop activities?

Signatures Required:

Safety Officer of the Day_________________________________________

Welding Instructor ______________________________________________