Hot Work Permit_Murray Library

Hot Work Permit - Murray Building Renewal Specific

HSEOP-10-12
Seek an alternative / safer method if possible!

This permit requires 72 hours notice prior to work commencing.
This Hot Work Permit is required 72 hours in advance of any operation that involves burning, welding, using an open flame, fire, or spark-producing tools, or that produces a source of ignition. This work includes, but is not limited to, welding, brazing, cutting, grinding, soldering, thawing pipe, torch-applied roofing, and chemical welding.
Project *
Date*

MonthDayYear
Date
Your Cell Phone Number*
So we can text you if there is a problem with the form. Format: (000) 000-0000.
Email*
example@example.com
Company*
Time Work Starts*

(Time work commences)

AM/PM Option
Time Hot Work Complete*

(Time the work is complete)

AM/PM Option
Fire Watch Time Complete*

Hour Minutes

AM/PM Option
Location/Building/Floor*
Work to be done*
THIS PERMIT IS GOOD FOR 24 HOURS
YesN/A
YesN/A
Requirements within 35 ft. (11m) of hot work:
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
Requirements for hot work on walls, ceilings, or roofs:
YesN/A
YesN/A
Requirements for hot work on enclosed equipment:
YesN/A
YesN/A
YesN/A
Requirements for hot work fire watch and fire monitoring:
YesN/A
YesN/A
YesN/A
YesN/A
- will take place after four hours- will involve a comprehensive inspection including the use of thermal scanning after the 60 min. watch.
Supervisor Authorizing Hot Work: *

First NameLast Name
Supervisor Authorizing Hot Work Signature*

Clear
Permit Authorizing Individual: (This will generally be a PCL representative)

First NameLast Name
Permit Authorizing Individual (PAI) Signature

Clear
Fire Watch Name: *

First NameLast Name
Fire Watch Signature*

Clear
I verify that the above location has been examined, the precautions marked on the checklist above have been taken, and permission is granted for this work.
Should be Empty:

Hot Work Permit - Murray Building Renewal Specific

Seek an alternative / safer method if possible!

THIS PERMIT IS GOOD FOR 24 HOURS

Requirements within 35 ft. (11m) of hot work:

Requirements for hot work on walls, ceilings, or roofs:

Requirements for hot work on enclosed equipment:

Requirements for hot work fire watch and fire monitoring: