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Date
BUILDING NAME,BLDG#,ROOM#,LOCATION
PERMIT
REQUEST
PERMIT
EXPIRES
Flammable liquipment in good repair
Lockout / tagout required
oil deposits removed
Comments:
HOT WORK PERMIT SHALL BE APPROVED BY EESH MEMBERS BEFOR START THE WORK
Available sprinklers ,hose streamsn
and extinguishers are in service
Confined space entry permit required
Area is protected with smoke or heat detection
Hot work equipment in good repair
Ample ventilation to remove smoke / vapor
Requirements within 35ft of work
from work area
REQUIRED PRECAUTIONS CHECKLIST
Fire watch may be required for adjoining areas ,
above and below
NOTE
Hot work area inspected 30 minutes after job
is completed
Other precautions taken
SIGNATURE OF CHWS
work breaks
Fire watch is supplied with suitable extinguishrrs
EESH APPROVAL
Fire watch is trained in use of this equipment and
in sounding alarm
DATE
TIME
Containers purged of flammable liquids & vapors
Fire watch/hot work area monitoring
DATE
TIME
Fire watch will be provided during and continuously
for 30 minutes after work ,including during any
NAME OF COMPETENT HOT WORK SUPERVISOR
No danger exists by conduction of heat into
(CHWS)
another room or area
Contact
#
...................................................
Enclosed equipment cleaned of all combustibles
NAME OF HOT WORK OPERATOR
elevated hot work
Work on walls or ceilings/enclosed equipment
I verify the above location has been examined , the
precautions checked on the required precautions
checklist have been taken to prevent fire,& permission
is authorized for work
Construction is noncombustible and without
combustible covering or insulation
combustibles on other side of walls moved away
Combustible floors wet down
Combustible floors wet down covered with
damp sand or fire resistant sheets
Remove other combustibles where possible
NATURE OF JOB
otherwise protect with fire resistant tarpaulins ,
screens or shields
All wall and floor openings covered
Fire resistant tarpaulins suspended beneath
This hot work permit is required for any operation involving open flames or producing heat & /or
sparkes & must be completed by a competent Hot Work Supervisor (CHWS) & posted at the site hot
work includes , but is not limited to : brazing,cutting , grinding, soldering & welding.
If the required precautions cannot be met , Hot Workis not permitted
HOT WORK BY
Explosive atmosphere in area eliminated
CONTRACTOR
LG-SHAKER
Floors swept clean of combustibles
HOT WORK PERMIT
Applicant
Applied
Dept.
Manager
EESH&FE
Manager
File No.
LG(10)A-3031-12-09