Hot Work Permit (Sample)

Details

Issued to: Company name Phone number Description of work

Location of work System/equipment I.D Permit Date and Time Work Start Date: Work Start Time: Work End Date: Work End Time: Issuer: (Print name) Hazard and precautions checklist Hazard present: YES NO Removed

or Controlled

Hazard present: YES NO Removed or Controlled

Any fire detection impairments nearby?

Confined space

Combustible solids Work at height

Flammable liquids No segregation of work from others

Combustible building fabric (floors, walls, ceilings, roofs)

Pressure (pipes or vessels discharged and vented)

Flammable/toxic gases/vapours

Conduction of heat/sparks

Chemicals Other

Additional precautions required (e.g. PPE, isolations, fire-fighting equipment, fire watcher):

Additional Information:

Authorisation before work starts The area is prepared and work may start in line with the conditions of this permit. Name of Permit Issuer Signed Date/Time

I have read and understood the conditions of this permit and will ensure that all workers understand the requirements. Name of Permit Acceptor Acceptance signature Date/Time

Cancellation after work is completed

The above work has/has not been completed and the area is safe for normal working to resume. Signed (Permit Acceptor) Signed (Permit Issuer) Date/Time Date/Time