Hot work Permit
UNCH - Surgical Tower
SECTION 1 - General Information
Contractor Performing Work
Location of Work
Date
/
Month
/
Day
Year
Date
Begin Hot Work at:
Hour Minutes
AM
PM
AM/PM Option
Complete Hot Work at:
Hour Minutes
AM
PM
AM/PM Option
Description of Work
Type/description of Hot Work to be performed (check all that apply)
Description
Welding
Cutting
Burning
Heating
Grinding
Other
Supervisor in Charge of Hot Work
Supervisor's Phone number
Craft Persons
# of Fire Watch/Names
Supervisor's Email Address
example@example.com
SECTION 2 - CHECKLIST (to be completed prior to hot work activity)
Emergency Plan
Fire Response Plan finalized / Emergency phone numbers on hand
Daily Hazard Analysis reviewed and signed
Fire Prevention
Fire extinguishers present within 30 feet of hot work
Fire extinguishers fully charged and functional with proof of inspection
Bucket filled with sand (at least three gallons) and present within 30 ft. of work (optional)
Trash removed to at least a 25 foot radius around work – (Note: 35’ radius in NYC)
Combustible brush cleared to 25 foot radius around work - (Note: 35’ radius in NYC)
Tall grass trimmed / dry grass wet down to 25 foot radius around work - (Note: 35’ radius in NYC)
Work surfaces checked for lead / lead removed if necessary
Tools Checklist
Proper PPE worn by craft (welding hood, cutting goggles, gloves, etc)
Flash screen in place / flash point undetectable by others
Oxy./acetylene hoses and fittings inspected for cracks and leaks
Reverse flow check valves installed at torch end
Flashback arrestors at torch end and regulator
Stub bucket provided (welding only)
Friction striker provided (for igniting torch)
Compressed gas cylinders secured and out of the way
Checklist performed/signed by
Skanska representitive approving this permit
Skanska representitive's signature
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SECTION 3 - Final Inspection
Hot work for the day is complete
additional fire hazards
Hot work equipment properly shut down / secured / stored
Work area inspected 30 minutes after work completed for smoldering material
Final Inspection Date
/
Month
/
Day
Year
Date
Final Inspection Time
Hour Minutes
AM
PM
AM/PM Option
Foreman:
First Name
Last Name
Foreman Signature
Comments
Save
Submit Final Inspection
EHS Manual Forms – Hot Work Permit - Rev 2 - Oct 2017
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