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STOP! Before starting hot work, review all safety precautions. This hot work permit is required for any temporary operation involving open flames or producing heat and/or sparks such as welding, cutting, brazing, grinding, soldering, or torch-applied activities. Rev. 0 – 08/2021 Part 1 Permit Number Instructions Required Precautions Checklist Supervisor: 1. Complete precaution checklist at right 2. Complete this form and retain Part 1 3. Issue Part 2 to competent person performing hot work ❑ Sprinkler protection in service (if present) and hose and extinguishers available ❑ Hot work equipment is in good working order Requirements within 35 ft. of hot work ❑ Flammable liquid, dust, lint, and oily deposits removed, and floor swept clean ❑ Explosive atmosphere in area eliminated (hot work is not to be conducted in a classified area unless made safe) ❑ Nearby activities evaluated for conditions that could be affected by hot work ❑ Path of likely sparks evaluated ❑ Combustible floors wet down, covered with damp sand or fire-resistive sheets ❑ Remove other combustible material where possible. Otherwise, protect with approved welding pads, blankets and curtains or metal shields ❑ All wall and floor openings covered ❑ Fire resistive covers and metal shields provided as needed ❑ Protect or shut down ducts and conveyors that might carry sparks to distant combustible material ❑ An appropriate fire extinguisher is located in the hot work area Hot work on walls, ceilings, or roofs ❑ Construction is noncombustible and without combustible covering or insulation ❑ Combustible material on other side of walls, ceilings or roofs is moved away Hot work on enclosed equipment (i.e., welding on the outside of tanks) ❑ Enclosed equipment cleaned of all combustible material ❑ Containers purged of flammable liquid/vapor ❑ Pressurized vessels, piping and equipment removed from service, isolated, and vented Hot work inside of enclosed spaces (i.e., inside of tanks) ❑ Adequate ventilation provided ❑ Atmosphere checked with gas detector per confined space permit ❑ Area purged of any flammable or toxic vapors ❑ Other permits completed as required: Lock-out/tag-out, working at heights, live electrical work Hot work/Fire Safety Notifications ❑ Location of nearest fire alarm known ❑ If no alarm present, what method will be used to raise the alarm? (List in other precautions area below) ❑ Escape routes maintained and known by personnel Fire Watch/Hot work area monitoring ❑ Fire watch will be provided for a minimum of 60 minutes after work has ceased. ❑ Fire watch is provided with suitable extinguishers ❑ Fire watch trained in use of equipment and in sounding alarm Other Precautions/Special Instructions: ❑ Permit Information Hot work done by: ❑ Employee ❑ Contractor Location/ building and floor: Reason for job: PPE Required: ❑ Welder’s hood with appropriate lenses ❑ Welder’s gloves ❑ Leather jacket/clothing ❑ Head Protection ❑ Hearing Protection ❑ Respirator Type/cartridge: ❑ Other: Hot Work Performer Name: Signature: I verify the above information has been examined, the precautions checked on the Required Precautions Checklist have been taken to prevent fire, and permission is authorized for this work. Hot Work Supervisor Approval Name: Signature: Date: Permit Dates Permit Activated Date: Time: Permit Expires Date: Time: Date and time work completed Date: Time: Final Fire Watch Check-up Date: Time: Fire Watch Inspector Signature (below) Signature: Atmosphere Monitoring Initial Test During Hot Work Operations Test(s) to be taken Acceptable Range Time Reading Time Reading Time Reading Time Reading Percent of Oxygen (O2) 19.5% to 23.5% Lower Explosive Limit (LEL) Below 0% Carbon Monoxide (CO) Below 35 ppm Hydrogen Sulfide (H2S) Below 10 ppm Instrument Used: