Form Title: Hot Work Permit

Document Code:

HOT WORK PERMIT

PROJECT NAME PERMIT NUMBER
NAME OF REQUESTOR DATE OF PERMIT REQUEST
NAME OF CONTRACTOR STARTING DATE END DATE
PROJECT LOCATION FOR HOT WORK PERMIT:___________________________________________________________
Type of Activity
Welding Cutting Grinding Finishing
I. List of person(s) inlcuding designation who will perform the hot work activity (use another sheet if necessary):
NAME DESIGNATION SIGNATURE
1. Fire watch ____________________________ ____________________________
2. Welder ____________________________ ____________________________
3. Emergency responder ____________________________ ____________________________
(use another sheet if necessary):
II. Area location of hot work activity: o Open area o Confined space area
NOTE: For hot work done inside confined space; accomplish confined space permit before proceeding with hot work activity.
III. Gas Welding Tanks Checklist
Check items Remarks
Are gas cylinders stored upright and secured with chain to prevent falling?
oY oN oN/A
Are cylinders legibly marked to clearly identify the gas contained?
oY oN oN/A
Are cylinders regularly examined for obvious signs of defects, deep rusting, or
leakage ? oY oN oN/A
Are valves protectors placed on all cylinders not in use?
oY oN oN/A
Are hoses free from damage?
oY oN oN/A
Are pressure gauge in operable range?
oY oN oN/A
Note: If there is NO answer in the checklist above, correct the non-conformity prior to start of activity.
IV. Personal protective equipment required
o Protective clothing o Hand protection o Foot protection
o Eye Protection o Respiratory protection o Head protection
V. HAZARDS VI. SAFETY PRECAUTION REMARKS
Exposure to sparks or flames oY oN Worker wearing fire retardant suit oY oN o N/A
oY oN Worker wearing welder helmet oY oN o N/A
Exposure to welding fumes
oY oN Fume Extractor are available on site? oY oN o N/A
Presence of combustible and
Flammable and combustible liquids are
flammable material near hot work oY oN oY oN o N/A
removed
operation
Fire oY oN Fire extinguisher available on site oY oN o N/A

Inspect tools and equipment prior to

Defective tools / equipment (ex.
oY oN use and put a tag if defective and pull oY oN o N/A
leaking cylinder)
out from service.

VI. APPROVAL(s)
I verify that the area of hot work operation has been examined, the precautions have been taken to prevent fire, and permission is
authorized for this work.
Prepared by:
Printed Name: _____________________________ Signed: _______________________ Date: ________________
(Project In Charge/ Team Leader)
Approved by:
Printed Name: _____________________________ Signed: _______________________ Date: ________________
(Safety Officer)
Noted by:
Printed Name: ____________________________ Signed: _______________________ Date: ________________
(Project Manager)