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Hot Work Permit (Notification of Work)

Technician Completing Work 

Person/Dept Requesting Work 

Building

Nature of Job or Object:

Does fire alarm and/or sprinkler system need disabling, and by WHO:

Requirements within 10 m (35 ft) of work:

Flammable liquids, dust, lint and oil deposits removed

Explosive atmosphere in area eliminated

Floors swept clean

Combustible floors wet down, covered with damp sand or fire-resistant sheets

Remove other combustibles where possible. Otherwise protect with fire-resistant tarpaulins or metal shields

All wall and floor openings covered

Fire-resistant tarpaulins suspended beneath work

Work on wall and floor openings covered:

Construction is noncombustible and without combustible covering or insulation

Combustibles on other side of walls moved away

Enclosed equipment cleaned of all combustibles

Fire watch/hot work area monitoring:

Fire watch personnel will be provided during and for 30 minutes after work is completed

Fire watch personnel are supplied with suitable extinguishers

Fire watch personnel are trained in use of this equipment and in sounding alarm

Fire watch personnel are may be required for adjoining areas above and below

Monitor hot work area for 30 minutes after job is completed

Other precautions taken:

Confined space entry permit

Ample ventilation to remove smoke/vapor from work area

Lockout - Tagout

Screen or barrier to protect faculty, staff, students, and visitors

Expected Date and Start Time:

Expected Date and End Time:

Keys issued: Yes No

Person Completing Form: