Hot Work Permit
Permit No: _________________________________________
A. Proposal
To be completed by the person responsible for carrying out the work.
Location of work: _____________________________________________________
Nature of work: _______________________________________________________
I have examined the above location and the precautions listed on the Hot Work Permit Checklist have been completed. I understand the precautions to be taken.
Signed: _____________________________________ Date: _____/____/________ Time: _______
Name (Print): ______________________________ Position: __________________________________
Company: __________________________________
B. Agreement
To be completed by the church official responsible for overseeing the work.
This Hot Work Permit is issued subject to the following conditions:
Time of issue: _______ Time of expiry: _______
A final check of the work area shall be made not before: _______
Additional conditions required: __________________________________________________________
Signed: _____________________________________ Date: _____/____/________
Name (Print): ______________________________ Position: __________________________________
C. Fire Watch
To be completed by the worker or contractor responsible for the work before returning this permit to the issuer.
The work area and all adjacent areas to which sparks and heat might have spread have been inspected and found to be free of fire following completion of work.
Time inspection completed: _______ (at least 1 hour after work was completed)
Signed: _____________________________________ Date: _____/____/________
Name (Print): ______________________________ Position: __________________________________
Company: __________________________________
Hot Work Permit Checklist
Fire Protection (tick appropriate boxes)
☐ Fire extinguisher suitable for the type of possible fire is available and operable
☐ Fire hose is available and operable (where applicable)
☐ Sprinklers are in service (where applicable)
Precautions within 10 metres of work
☐ Flammable liquids, dust, lint, and oily 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 walls or ceilings
☐ Construction is non-combustible and without combustible covering or insulation
☐ Combustibles on the other side of walls moved away
Work on enclosed equipment
☐ Enclosed equipment cleaned of all combustibles
☐ Containers purged of flammable liquids/vapours
Fire watch/hot work area monitoring
☐ Fire watch will be provided during and for at least 30 minutes after work, including any coffee or lunch breaks
☐ Fire watch is supplied with suitable extinguishers
☐ Fire watch is trained in the use of this equipment and in sounding the alarm
☐ Fire watch may be required for adjoining areas, above, and below
☐ Monitor hot work area for 4 hours after job is completed
Other precautions taken
☐ ___________________________________________ ☐ ___________________________________________
Remember: If you cannot comply with these precautions, do not proceed with the Hot Work.