Hot Working Permit

Page 1 of 3

PART A1 - A6 Completed by Issuer

A2 - PERMIT
VALID FROM
Permits may only
be issued up until
4pm each day.
Permits are only
valid for one day.
A new permit is
required each day.

Ti
me

Da
te

T
O

Ti
me

A1 - Permit Number:

Da
te

A3 - WORK DETAILS
Contractor name

Person requesting permit

Exact location of Hot Work

Nature of Hot Work (i.e. Arc, gas welding, grinding)
Description of works

A4 - RISK ASSESSMENT
HAZARD IDENTIFIED

RISK

CONTROLS

A5 - ISOLATION OF FIRE ALARM *some notice may be required*

Details of Authorised Person
Person who will disable alarm
Detail here measures to isolate fire alarm system

A6 - PERMIT AUTHORISATION
By authorising this permit - I confirm that the relevant Site Technical Officer / Site Manager / Premises
Officer / Maintenance Manager has been notified of the works.
Signed

Print

1. One signed copy of this permit to be retained by the issuer.

2. The contractor is to present his copy to the Premises Officer to obtain keys, etc.
3. Upon completion of the works. The contractor is to return the completed form to the issuer.

Date
Form design 10 Aug 2009
L R Welling

Hot Working Permit

Page 2 of 3

PART B1 - B5 - Completed by Contractor

B1 - Receipt by Contractors Representative
The contents of the Hot Working Assessment have been fully explained to me and I understand the requirements
and responsibilities placed upon me.
If any changes occur in the nature or scope of the work, or unforeseeable hazards are identified after the
work has started, the Hot Work must cease immediately and the permit issuer contacted.
Signed

Print

Date

B2 - Hot Work Assessment - Prior to Works Commencement

Have fire doors with magnetic hold open devices, in the vicinity of the works, been closed?
Are floors and surrounds swept clean and clear of rubbish?
Has all combustible stock, plant, insulations etc been located 12m from the operation or the remainder protected from heat and
sparks with non-combustible curtains, metal guards or flame-proofed covers (not ordinary tarpaulins)?
Has any floor or wall opening or open mesh flooring within 12m of the cutting and welding operations been covered over tightly?
Has a trained, responsible person with authority to stop the work and to regularly check the area, particularly during lunch breaks
and rest periods, been appointed?
Has a trained, responsible person been assigned to watch for dangerous sparks in the area, as well as floors above and below in
adjacent areas?
Has contractor fire fighting equipment (e.g. extinguishers, water/sand buckets, fire blankets) been provided, NOT ISS equipment?
Have all operatives undertaking the works been trained in the use of the fire fighting equipment?
Have warning notices been posted adjacent to, and where necessary, below the work area?
Are all gas cylinders safely secured in upright positions and gas pipes and cable in good condition properly secured and kept as
short as possible?
Do the operatives know where the nearest fire alarm break glass point is located?
Is the work permit clearly displayed at the job location?
Has the work area been designated a no smoking area?
Do all staff know the procedures for discovery of a fire and raising the alarm?
Is correct Personal Protective Equipment provided and worn in relation to the task?
If Tar boilers are used on roofs, has a non combustible heat insulating base been provided to prevent heat igniting the roof?
Are Tar boilers supervised by experienced persons and never left unattended unless switched off?
If operating adjacent to a gas supply, has the gas been turned off or the pipe protected?
Are gas cylinders positioned 3 metres away from the burner?
Have flash back arrestors been fitted to gas cylinders?
Have welding, cutting or grinding operations been screened off using a non combustible material?
1. One signed copy of this permit to be retained by the issuer.
2. The contractor is to present his copy to the Premises Officer to obtain keys, etc.
3. Upon completion of the works. The contractor is to return the completed form to the issuer.

Form design 10 Aug 2009

L R Welling

Hot Working Permit

Page 3 of 3

Are facilities available to summon assistance in the event of an emergency?

B3 - Record of Incidents

B4 - Completion
The work area must be checked at 3 stages upon completion: - Immediate completion, after 30mins and after 1
hour.
IMMEDIATE CHECK
Is work area clean, tidy and safe?
Have checks been made for smouldering debris?
Have all detector head covers been removed?
Have all fire alarm zones been checked, confirmed as operational and the system been put online?
30 MIN CHECK
Work area checked at:-

30 minutes

1 HOUR CHECK
Work area checked at:-

1 hour

B5 - Completion sign off

To be signed by the competent person on completion of ALL tasks
By signing, I confirm that notification has been given to the permit issuer for re-activation of the fire
alarm system
Signed

Print

Time

Upon completion of this permit, it must be returned to the issuing authoriser.

A sketch of the area should be attached.

1. One signed copy of this permit to be retained by the issuer.

2. The contractor is to present his copy to the Premises Officer to obtain keys, etc.
3. Upon completion of the works. The contractor is to return the completed form to the issuer.

Form design 10 Aug 2009

L R Welling