Provide complete identification and contact information for the facility, primary contractor, and any subcontractors involved in the hot work operations. All fields marked mandatory must be completed to process this permit.
Facility or Building Name
Facility Full Address
Precise Work Location Within Facility
GPS Coordinates (Optional)
Primary Contractor Company Name
Contractor License or Registration Number
Site Superintendent Full Name
Site Superintendent Contact Number
Are subcontractors involved in this hot work activity?
Permit Issuance Date
Planned Work Start Time
Planned Work End Time
Work Shift Classification
Day Shift (06:00-18:00)
Evening Shift (14:00-02:00)
Night Shift (22:00-10:00)
Weekend/Holiday
Emergency Contact Name (24/7)
Emergency Contact Phone
Facility Manager or Responsible Person On-Duty
Select all sensitive occupancies within 100 meters of hot work zone
Hospitals or medical facilities
Schools or educational institutions
Residential buildings
High-occupancy commercial centers
Chemical storage or processing
None of the above
Detail the specific hot work activities to be performed and complete a thorough equipment inspection. Any failed inspection items must be corrected before permit approval. Attach additional sheets if multiple equipment units are used.
Types of hot work activities to be performed (select all that apply)
Arc Welding (SMAW, GMAW, GTAW)
Oxy-Fuel Cutting or Welding
Plasma Cutting
Angle Grinding or Abrasive Cutting
Soldering or Brazing
Other hot work process
Detailed Description of Work Scope and Objectives
Hot Work Equipment Inventory and Pre-Use Inspection
Equipment ID or Serial Number | Equipment Type | Manufacturer and Model | Last Certified Inspection Date | Visual Pre-Use Inspection Passed | Inspector Name or Initials | |
|---|---|---|---|---|---|---|
WLD-001 | MIG Welder | Lincoln Electric PowerMIG 350 | 5/15/2025 | Yes | J.A. | |
CUT-002 | Plasma Cutter | Hypertherm Powermax65 | 6/1/2025 | Yes | J.A. | |
Did all equipment pass pre-use inspection without critical deficiencies?
Hot Work Operator Full Name
Operator Certification or License Number
Operator Certification Expiry Date
I confirm the operator has valid certification and is competent to perform the specified hot work
Select all required Personal Protective Equipment (PPE) verified for use
Welding helmet with appropriate filter shade
Fire-resistant clothing (FRC) or leather apron
Safety glasses with side shields
Steel-toed safety boots
Leather welding gloves
Hearing protection
Respiratory protection (PAPR/SCBA)
Face shield for grinding operations
Primary Energy Source for Equipment
480V 3-Phase Electrical
240V Single-Phase Electrical
Oxy-Acetylene Gas Cylinders
Propane Fuel System
Diesel Generator
Other energy source
Is electrical equipment properly grounded and GFCI protected where required?
Are compressed gas cylinders secured upright, caps in place, and regulators functioning properly?
Conduct a thorough survey of the work area and implement robust isolation measures. All combustible materials must be removed or protected, and fire suppression equipment must be readily accessible and functional. This section requires physical verification before permit approval.
Have all combustible materials within 10-12 meters (35 feet) been identified and documented?
Rank the following isolation methods by priority of implementation (1 = highest priority)
Physical removal of combustibles | |
Application of fire-retardant covers | |
Wetting down surfaces with water | |
Establishment of fire-resistant barriers | |
Purging with inert atmosphere |
Fire Suppression Equipment Verification Checklist
Equipment Type (Extinguisher/Standpipe/Hose) | Exact Location Near Work Area | Last Inspection or Service Date | Pressure Gauge Reading or Status | Access Path Clear and Unobstructed | Verified By (Initials) | |
|---|---|---|---|---|---|---|
CO2 Extinguisher 15 lbs | 3 meters south of work | 6/1/2025 | Green/Full | Yes | M.R. | |
Fire Hose Station 2A | Adjacent corridor east | 6/20/2025 | Pressurized | Yes | M.R. | |
Is a dedicated fire water supply or standpipe system available within 15 meters?
Has atmospheric testing been completed in enclosed or confined spaces?
Is mechanical ventilation active and adequate to remove smoke and fumes?
I confirm all floor and deck openings within 10 meters are covered with fire-rated materials
I confirm all wall and partition openings are sealed to prevent spark transmission
I confirm all floor drains and openings are covered with fire-resistant dampers or plugs
Are emergency access routes and exits clear and marked for evacuation?
Continuous monitoring is mandatory during all hot work operations and for a minimum 60-minute post-work fire watch. The fire watch must maintain this log and remain in the immediate area with appropriate suppression equipment. Any alarm conditions require immediate cessation of work.
Is a dedicated, trained fire watch assigned exclusively to this hot work operation?
I verify the fire watch holds current certification in fire prevention and suppression
Continuous Fire Watch and Gas Monitoring Log (Record at minimum every 30 minutes)
Monitoring Time | LEL Reading (%) | O2 Reading (%) | Visual Conditions (Sparks/Smoke/Hot Spots) | Fire Watch Initials | Work Area Safe to Continue | |
|---|---|---|---|---|---|---|
8:00 AM | 0 | 20.9 | Clear, no issues | JW | Yes | |
8:30 AM | 0 | 20.8 | Minor sparks contained | JW | Yes | |
Primary Communication Method Between Fire Watch and Operators
Two-Way Radio (Channel Specified)
Mobile Phone
Visual Line of Sight
Audible Signals
Other communication method
Fire Watch Observations, Incidents, or Near-Misses During Monitoring
Fire Watch Rotation Interval (if multiple watches)
Are gas detector alarm set points configured and tested (typically LEL >10% alarm)?
Select all visual observations being monitored during fire watch
Spark dispersion outside containment
Discoloration of fire-retardant covers
Smoldering debris or hot spots
Smoke generation and drift
Combustible material disturbance
None - conditions normal
Frequency of Adjacent Area Monitoring Beyond Immediate Zone
Every 15 minutes
Every 30 minutes
Every hour
Continuous visual monitoring
Only if initial alarm triggered
Final authorization requires joint verification by Site Safety Director and Fire Watch Lead that all precautions are in place. This permit is invalid without both signatures. Post-work inspection must confirm area is fire-safe before final permit closure.
Pre-Work Final Verification Checklist (All items must be confirmed)
All combustibles removed or protected
Fire suppression equipment tested and accessible
Fire watch briefed and in position
Atmospheric testing completed (if required)
Ventilation confirmed adequate
Emergency procedures reviewed
Communication systems tested
Adjacent areas notified
Overall Pre-Work Risk Assessment Rating (1 = Low Risk, 5 = Extreme Risk)
Site Safety Director Authorization - By signing, I confirm that all safety measures have been implemented and the hot work can proceed safely under the conditions specified.
Site Safety Director Printed Name
Site Safety Director Signature
Authorization Timestamp
Fire Watch Lead Acknowledgment - By signing, I accept responsibility for continuous fire monitoring and confirm I understand my duties, have necessary equipment, and will remain in the hot work area for the required duration.
Fire Watch Lead Printed Name
Fire Watch Lead Signature
Acknowledgment Timestamp
Permit Valid From
Permit Valid Until
Has post-work fire watch inspection been completed for minimum 60 minutes after final hot work?
Is the hot work area and all adjacent zones confirmed clear of smoldering materials, sparks, or fire hazards?
I confirm fire watch was maintained continuously during work and for full 60-minute post-work period
Final Permit Closure Signature (Site Safety Director or Designee)
Permit Closure Timestamp
Lessons Learned, Observations, or Recommendations for Future Permits