permit to work - hot work

This permit is to be applied for all hot work outside of any workshop welding bay or similar. Hot work includes welding, grinding, hot air paint stripping, flame cutting and the use of blow lamps and bitumen boilers.

Part 1- Job details / To be completed by the Authorised Permit Issuer
Permit reference number:
Nature of job including type of hot work:
Site location and address:
Exact work location:
If a sub-contractor, please give full details:
Work to be carried out by: (name all workers)
Confirm that there is a risk assessment and method statement specifically covering the tasks involved and the location. / Yes
Part 2 - Precautions / To be completed by the Authorised Permit Issuer after obtaining confirmation of precautions from the work supervisor /
Who is appointed for fire watch duties?
Types and sizes of fire extinguisher available:
(Normally at least two “A rated” extinguishers to be available)
Yes / No / N/A
Fire extinguishers are suitable, appear to be in good condition and have been serviced in the last year.
The area is clear of combustible materials, flammable liquids and gases, so far as reasonably practicable.
Atmosphere has been checked for flammable gases.
Neighbouring areas have been assessed for any risk of fire spread, e.g. by conduction along metal pipes, falling sparks, risk to fillings within insulated panels.
Suitable measures have been taken to prevent fire, e.g. damping down, ongoing spraying, covering with fire-resistant materials, blocking holes in floors, walls, ceilings etc.
Sprinklers are in working order.
Smoke detectors have been isolated or covered as needed.
Details of smoke detectors covered or isolated:
Barriers/screens will be used where needed to protect other building users.
Personal protective equipment is available and will be used as specified in the risk assessment/method statement.
All workers understand the premises’ fire procedure.
A copy of this permit has been provided to staff involved in the
work.
Note. For a valid permit to be issued only unshaded “Yes”, “No” or “N/A” boxes may be ticked
Details of any remaining hazards in the area:
Details of any special precautions required by the permit issuer:
Arrangements for summoning emergency assistance:
Part 3 - Authorisation - to be completed by the Authorised Permit Issuer
I authorise the work to be carried out and have notified the relevant personnel.
Name (print):
Signed: Date: Time:
Permit commences: (Insert time and date)
Permit valid until: (Insert time and date)
Note: A new permit will be required if the work does not commence within the specified period.
Part 4 - Receipt - to be completed by person in charge of the work
I’ve read and understood the conditions of this permit and am familiar with the risk assessment for the work. I accept responsibility for undertaking the work specified above in a safe manner. I declare that neither I nor those persons within my control will attempt any tasks other than those specified in this permit to work and any associated safe system of work.
Name (print):
Signed: Date: Time:
Part 5 - Hand back - to be completed by person in charge of the work
I certify that the work has been completed and the work area left in a safe condition.
I certify that a fire watch has been carried out for one hour after the cessation of hot work.
Name (print):
Signed: Date: Time:
Part 6 - Cancellation - to be completed by the Authorised Permit Issuer
I certify that the work has been satisfactorily completed and the work areas left in a safe condition.
I certify that any smoke detectors which were isolated as detailed in the permit to work, have been reinstated, and the fire alarm is now fully operational. Yes or N/A
I certify that the work area and all areas identified as being at risk of fire, have been inspected.

This permit is hereby cancelled.
Name (print):
Signed: Date: Time: