HOT WORK PERMIT

PERMIT NO: ISSUED ON: EXPIRES ON: TIME:

CONTRACTORS PERMIT TO CARRY OUT HOT WORK

PERMIT APPLICATION
COMPANY NAME:
SUPERVISOR'S NAME:

SIGNATURE:
DATE:
I APPLY FOR A PERMIT TO CARRY OUT HOT WORK IN RESPECT OF THE FOLLOWING :
LOCATION:
OPERATION:
START TIME:
FINISH TIME:
OPERATIVES NAMES:

1 Rules and understand the restrictions they place on my work- 5 The operatives. including the fireman, have been Instructed in the building
I also confirm that my work will be carried out in accordance fire procedures and the whereabouts of fire alarm points and telephones
with best current trade practice and that all Appropriate
Health & Safely controls will be observed.

2 The site has been examined and there are no combustible
Liquids. Vapors, gases. Dusts or other materials in the vicinity
of the work.
3 All combustible materials have been removed or protected
against heat and from ignition the fire risk. His role will be
that of a fireman and he will not be directly involved in any
part of the works
4 Throughout the work an operator trained in the use of fire
appliances will stand by with an appliance appropriate to the
fire risk. His role will be that of a fireman and he will not be
directly involved in any part of the work.
6 Any change in the scope of works or the Circumstances detailed and
assumed In the permit automatically revoke the permit. Such changes
must be notified to the Facility manager Immediately. This permit does
not authorize work on any asbestos based Material for which a
separate PERMIT TO WORK is required
7 This permit is applicable to all work involving, flame, hot air arc welding
and cutting equipment, bracing and soldering (excluding the use of electric
soldering irons) Blow lamps bitumen boilers, angle grinders and a11)'
other heat producing equipment.
8 All wall and floor openings covered. Available sprinklers, hose streams
and extinguishers are in service/ operable. FM approved welding pads,
blankets and curtains installed under and around work.

COMPLETION CERTIFICATE (TO BE COMPLETED BY CONTRACTOR)

 The work area and all adjacent areas to which sparks or heat might spread were thoroughly inspected on completion of the works and one hour later

 The work has been completed for the day as described in the application above

METHOD STATEMENT FOR PERMIT TO WORK AND/OR ACCESS PERMITS

BUILDING

FLOOR / LEVEL :
DESCRIPTION OF WORKS AND SPECIFICATIONS:

NOTE: For clarity, the method statement should also have drawings enclosed on the subject duly highlighted.

Agency Name Name of Supervisor / Manager

Date Signature:

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DELIVERIES:
Item to be delivered

Company Name expecting delivery:

____________________________________________________________

Contact Number:
_________________________________________________________________________

Item to be delivered / repaired/ replaced / serviced at/to:

___________________________________________

Expected time of delivery:

___________________________________________________________________

Lift required: Yes/ No. Items received:

VIOLATION – WRITTEN WARNING

Failure to respond to request from us regarding the following:

1. Wearing Hard Hats

2. Wearing proper footwear/Gloves/welding glass

3. Installing proper electrical plugs and sockets

4. Providing fire extinguishers as per requirement

5. Up keep of toilets

6. Misuse of toilets/use of toilets other than those designated

7. Well equipped First aid kit

8. Working on proper ladders

You will be penalized for NOT complying with the statutory requirements, after which any further
occurrence means you shall be removed from site.

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PERMISSION GRANTED TO CARRY OUT WORK
Date : Time: Name of Agency
Supervisor/Manager :

Name of the Facility Manager : Name of Authorised Admin officer :

Signature : Signature :

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