AC Hot-Work-Permit

Hot-Work Permit
Hot Work Procedure HSEOP-10-02

Hot-Work Permit Seek an alternative/safer method if possible!

This Hot-Work Permit is required for 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 Name
Date*

MonthDayYear
Date
Company*
Time Started *

Hour Minutes

AM/PM Option
Time Completed *

Hour Minutes

AM/PM Option
Location/Building/Floor*
Work to be done*
THIS PERMIT IS GOOD FOR 24 HOURS
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesN/A
YesNoN/A
Supervisor Authorizing*
Supervisor Authorizing Hot Work Signature*

Clear
Fire Watch 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.
What is your email?*
example@example.com (A copy of the final permit will be sent here.)
Should be Empty:

Hot-Work Permit