6601083 - 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.
Date*

YearMonthDay
Date
Project Number:*
Company*
Time Started:

Hour Minutes

AM/PM Option
Time Completed:

Hour Minutes

AM/PM Option
This permit expires on:*

MonthDayYear
Date
Location/Building/Floor*
Work to be done:*
THIS PERMIT IS GOOD FOR 24 HOURS
YesN/A
YesN/A
Requirements within 35 ft. (11 m.) 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
YesNoN/A
Signatures
Supervisor Authorizing Hot Work Name*
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.
STOP: Please call a Nordic PCL Representative to come and sign off as the Permit-Authorizing Individual (PAI)
Permit-Authorizing Individual (PAI) Name*
Permit-Authorizing Individual (PAI) Signature*

Clear
Should be Empty:

Hot Work Procedure HSEOP-10-02

HOT WORK PERMIT

THIS PERMIT IS GOOD FOR 24 HOURS

Requirements within 35 ft. (11 m.) 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.

Signatures

STOP: Please call a Nordic PCL Representative to come and sign off as the Permit-Authorizing Individual (PAI)