Hot Work Permit

Contract Name: Contract No.: Date:

Location: Time: Valid To:
Work Description:

Have You Checked the Following:

No. Requirement Yes No
1 Sprinkler system working / in service ☐ ☐
2 Cutting and welding equipment in good repair ☐ ☐
3 Floors swept clean of combustible materials within 10m of work area ☐ ☐
4 Flammable liquids removed ☐ ☐
5 If other combustibles cannot be removed, cover them with non-combustible blankets ☐ ☐
6 Explosive atmosphere in area eliminated ☐ ☐
7 All wall and floor openings within 10m covered ☐ ☐
8 Gas cylinders secured and protected from damage ☐ ☐
9 Combustibles moved away from other side of wall if working on walls or ceilings ☐ ☐
10 Sufficient and suitable fire extinguishers are available in hot work area ☐ ☐
Fire warden available for at least 30 minutes in the section and floors above & below where hot
11 ☐ ☐
work was completed and during any tea or lunch breaks
12 Fire warden knows how to use fire extinguishers and how to raise the fire alarm ☐ ☐
Welder to check work area after work is completed for sparks / heat that may have spread to the
13 ☐ ☐
floors above and below or opposite sides of the wall.

Welder

Name: Signature:

The above-mentioned location has been inspected and the precautions above have been taken to prevent a fire.
Permission is hereby granted to commence with work.

Maintenance Supervisor / Site Manager

Name: Signature:

NB: This permit does not apply to every welding / cutting situation. The specific circumstances of each welding and
cutting job should be carefully reviewed and appropriate safety precautions taken before work begins and while
performing the work. Assigning hot work in confined spaces will require a Confined Space Entry Permit.

Permit is Valid for 12 Hours

Refer SSB/HMS/PMT001 v1 08/2017

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Tmpt 11/2016