Sample hot work permit
Job/file number: ________________________________________________________________________
Location of work: ________________________________________________________________________
Description of work: ______________________________________________________________________
Authorized worker name(s) ________________________________________________________________
Fire watch name(s) ______________________________________________________________________
The above location has been inspected. The procedures below have been taken to prevent fire.
Permission is granted for this work.
Permit No. _______________________________ Date: _________________ Time: _________________
Expires on: _______________________________ Time: _____________ a.m./p.m.
Authorizing supervisor: ___________________________________________________________________
- Sprinklers are in service
- Cutting and welding equipment in good repair/inspected
Precautions within 35 ft. of work
- Floors swept clean of combustibles
- Combustible floors wet down, covered with damp sand or fire resistive material
- Flammable liquids removed
- Combustibles not removed protected with fire resistive tarpaulins or metal shields
- All wall and floor openings covered with fire resistant tarpaulins or metal shields
Work on walls or ceilings
- Fire resistive tarpaulins suspended beneath work
- Enclosed equipment cleaned of all combustibles
- Containers purged of flammable liquids or removed from area
- Combustibles moved away from other side of wall
- Construction is non-combustible including coverings or insulation
- Fire watch will be provided during and for at least 30 minutes after work is completed and during all breaks
- Fire watch is supplied with suitable extinguishers or charged small fire hose
- Fire watch has been trained in the use of fire fighting equipment and emergency procedures
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171-0933 (2/14) LC 11-399