Document Number

INTEGRATED MANAGEMENT SYSTEM

CRCC-IMS-HSE-P004
Rev. No. Rev. Date
WORK PERMIT PROCEDURE 0 17/05/2021
Page Number
HOT WORK PERMIT
1 of 2
Project Name Permit Number
Hot Work Permit
Note: This Hot Work permit denotes that a competent and experienced person has conducted a Risk Assessment of the proposed work and inspected
the workplace and has subsequently formulated appropriate control measures to eliminate and/or minimise potential risks to the health and safety of
site personnel. This permit must be completed and approved by the relevant CRCC Management personnel prior to any work commencing at the work
place/site. Only approved work, designated on this permit is to be performed.

1.0 Personnel Involved in Hot Work

Contractor/Employer Name:
Employee's Names: a) b) c)
SubContractors: a) b) c)
Project Supervisor: Work Requested by:
2.0 Details of Work to be Undertaken

3.0 Type of Equipment to be Used

a) Oxy/acetylene equipment b) Electric/spark generating equipment

c) LPG Equipment d) Other (please specify)_____________________________

Original to be Kept on Location Duplicate for HSE Files (retain until closed copy provided)

4.0 Site/Workplace Details

Location of work (e.g. block, building)

5.0 Potential Hazards

(i) Flammable liquids/materials Yes No

(ii) Explosive/toxic gas atmosphere Yes No

Confined space environment

(iii) (Note: a confined space permit and procedures will be required in addition to this permit) Yes No

(iv) Dust/particle generating activities Yes No

(v) Other (please specify) Yes No

6.0 Hot Work Precautions

a) Combustible materials removed 15m radius j) Atmosphere tested for explosive/toxic gas
b) Wet down non-removable combustible items k) Warning/mandatory signs in place
c) Cover drains with fire blankets 15m radius l) Barricades/fencing erected
d) Appropriate fire extinguishers on hand m) Air conditioning units isolated
e) Sparks from work at heights contained n) Safe access and egrees provided
f) Welders earthed to work at weld point o) Adjacent areas inspected and made safe
g) Exhaust spark guards fitted to machinery p) Ventilation/dust extraction units to be used
h) Electric leads placed correctly q) Fire/smoke detectors isolated (Refer to Section 7.0)
i) Electrical trace on pipelines isolated r) Other (please specify)
Responsible Person
Name: Signature:
Name :

Date:

7.0 Fire Protection System Isolation (Where applicable)

Note: Fire Protection/Detection Equipment IS NOT to be isolated by unauthorised or untrained persons. Approval is to be obtained from the Building
Manager/Security Shift Supervisor for isolation and reactivating the system.
Isolated: Time: am/pm Phone:
Name: Designation: Signature:
Activated: Time: am/pm Phone:
Name: Designation: Signature:
 Document Number
INTEGRATED MANAGEMENT SYSTEM
CRCC-IMS-HSE-P004
Rev. No. Rev. Date
WORK PERMIT PROCEDURE 0 17/05/2021
Page Number
HOT WORK PERMIT 2 of 2
8.0 Personal Protective Equipment
a) Eye protection (i) Welding helmet b) Hand protection (e.g. gloves, gauntlets)
(ii) Oxy/acet goggles c) Safety footwear
(iii) Goggles d) Protective clothing (overalls, apron)
(iv) Safety Glasses e) Hearing protection
(v) Face shield f) Safety helmets
(vi) Welding screens g) Respiratory protection
(vii) Other (please specify) h) Other (please specify)
Approved by: Project Supervisor: Signature:
Name (please print): Date:
9.0 Supervisor's Confirmation
I/We understand the procedures and precautions and will provide employees with the appropriate Personal Protective Equipment required to conduct the
"Hot Work" described within this permit. I/We will comply with all relevant Workplace Health and Safety Legislation and CRCC's Health, Safety and
Envionmental Standards.
Name (please print): Company Name:
Representative's Signature: Name (please print):
Date: Time: am/pm Valid until: Time: am/pm
10.0 Authorization to Proceed
The workplace described in Section 4.0 has been inspected and, in my opinion, is in a safe condition for the work described in Section 2.0 to proceed
provided that the precautions and procedures detailed within this permit are complied with.

Approved by: Name Signature:

a) Date: Time: am/pm Valid Until: Time: am/pm

Original Location Duplicate to Contractor File Triplicate for HSE File (Completion)
11.0 Supervisor's Completion of Work Declaration
a) All equipment /materials/waste have been removed from the workplace and the work has been satisfactorily completed.
IS FIT for further use?
b) All affected plant/machinery/equipment:
IS NOT FIT for further use?
c) All fire protection/detection equipment has been reactivated/returned to service (refer to section 7.0)
d) The following aspects of the work were considered to be unsatisfactory and are noted for attention prior to
undertaking similar operations. (Note: attach a separate sheet if necessary)
Company Name: Supervisor's Name:

Supervisor's Signature: Date: Time:

12.0 Acceptance of Completed Job

I accept the Contractor's Completion of Work Declaration that the work as defined within this permit has been satisfactorily completed and the workplace is
safe for normal use.

CRCC Area Supervisor: Name: Date: Time: