This form is to be filled out in its entirety by the responsible person actually performing the "HOT WORK" and then brought to the Department of Environmental and Occupational Health and Safety (EOHS) for approval prior to beginning the project.
| Company: | Date: |
| Responsible Person: | Start Time: |
| Work to be performed: | Building: |
| Room Number, Area or Equipment: | |
| Flame or spark-producing equipment to be used has been inspected and found in good repair. | |
| Sprinklers, where provided, are in commission and will not be taken out of service while this work is being done. | |
| There are no combustible fibers, dusts, vapors, gases or liquids in the area. Tanks and equipment previously containing such materials have been purged. The absence of gases or vapors has been verified by a combustible gas detection instrument. If there is a possibility of a leak developing in nearby piping, equipment, or tanks, this area is being continuously monitored. Call EOHS at Ext 3700 if assistance is needed to test area. | |
| Fire alarms will not be taken out of service while work is being performed. If alarm system must be inactivated during work then EOHS will be contacted prior to taking alarm out of service so that a suitable "fire watch" can be coordinated with campus police. Under no circumstances will fire alarms be taken out of service without contacting EOHS. | |
| The work will be confined to the area or equipment specified on this permit. | |
| Surrounding floors have been swept clean and, if combustible, wet down. | |
| Contractor has ample portable fire extinguishers available and trained personnel to use them. | |
| All combustibles have been relocated 35 feet from the operation and the remainder protected with metal guards or flame-proofed curtains or covers (not ordinary tarpaulins). | |
| All floor and wall openings within 35 feet of the operations have been tightly covered. | |
| Responsible personnel have been assigned to provide a "Fire Watch" for dangerous sparks in the work area, as well as on floors above and below while work is being performed. | |
| Arrangements have been made to provide a "Fire Watch" to patrol the area, including floors above and below, during any lunch or rest period and for at least one-half hour after the work has been completed. |
I attest that the above precautions have been taken ______________________________________
Person Responsible for performing the work
Approved_____________________________________________ Date_____________________________________
Director EOHS
NOTE: This permit expires 24 hours after the designated "start time". If work is to continue another permit must be issued.