Hot Work Permit

This permit should be completed by the authorised person prior to all hot work.

Note: ACTIA do not need to be notified of hot works

Section 1 – Details of Applicant and Authorised Person

Name of Applicant:

Permit number: (use this box for permit numbering system) #

Name of Authorised Person:

Section 2 – Details of Hot Work

Issue date: Issue time: Hot work location (incl. floor, building name etc.)
Valid for _____ hours/days*
*if multiple days’s work, every day Section 4, 5,6,7,8
must be reviewed to ensure no changes.

Description of work required:

Section 3 – Hot Work Activities

Details of work being conducted (please tick)

□ Welding – Oxy, Arc, Mig, Tig etc □ Brazing or soldering

□ Hot Cutting – Oxy, Plasma etc. □ Electric power tools (ignition source) near
combustibles

□ Grinding □ Heating

□ Other heat or spark producing activity. Details:

Section 4 – Hot Work Controls

These Controls are to be implemented before starting hot work

FIRE PROTECTION
Fixed equipment operational Yes / No
Fire hose supplied (if required) Yes / No
Correct class fire extinguisher available Yes / No
Automatic fire protection Yes / No
(detectors/sprinklers etc.) isolated
If fire protection systems isolated, a Yes / No
Fire Protection System Impairment Permit
has been completed
Safety observer appointed Yes / No
Workers and observer aware of fire alarm Yes / No
and phone facilities available at location
 SAFETY PRECAUTIONS FOR OTHER SITE USERS
Access to area restricted (warning signs, Yes / No
area taped off etc.)
Access to area prevented (barricaded, Yes / No
taped off etc.)
Warning signs in place Yes / No
Equipment protected in adjacent areas (incl. Yes / No
below and above)
Protective screens in place Yes / No
Safety Observer appointed Yes / No
Effective communication (2-way radio, Yes / No
phone etc.) in place
Correct PPE in use Yes / No

Section 5 – Reducing the Fire Risk

Surrounding and adjacent area cleared of Yes / No
combustible materials
Clear area of oil or flammable liquid spills Yes / No
Extension leads and tools clear or Yes / No
protected
Prevailing conditions (i.e. weather, Yes / No
ambient temperatures etc.) considered
Adequate ventilation available Yes / No
Safe entry and egress provided Yes / No

Section 6 – Atmospheric Testing

Is atmospheric testing required? Yes / No
Is continual monitoring required? Yes / No
Detector type: Detector serial number:
Next calibration due date:
Test date: Test time:
Test result (<5% LEL required)

Testing Officer: ___________________________________

Signature: _______________________________________
 Section 7 – Issue of Hot Work Permit
The above prescribed hot works will be conducted is safe and all control measures required are in
place and sufficient. During the hot works, if there are any safety concerns, cease all hot
works.
Name of authorising officer Name of person carrying out Name of safety observer
_________________________ work _________________________
_ _________________________ _
_
Signature Signature
Signature
_________________________ _________________________
_ _________________________ _
_

Safety Observer onsite Yes The fire watch will be implemented for ______ (time) after the
completion of work (Minimum of one hour)

Section 8 – Safety Observer Handover

Should the safety observer need to be relieved the following is to be completed

Relieving safety officer

I accept responsibility for maintaining the safety observer and fire watch duties (if applicable) from:

Date: _________________________ Time: _________ for ________ hours or until __________

time

Name: ___________________________________ Signature:

_______________________________

First safety observer

I hand over responsibility for the safety observer duties to:

__________________________________

Date: _____________________ Time: __________ Signature:

_____________________________

Section 9 – Sign Off of Hot Work Permit on Completion of Work

All hot work connected with this permit is now complete? Yes / No
All specific control measures have been removed? Yes / No
All fire detection and alarm systems have been restored to normal operation? Yes / No
A complete inspection of the area has been conducted and no hazards Yes / No
connected with the hot work exist?
The fire watch has been completed for the prescribed period? Yes / No

Signature (person carrying out work) Signature (authorising officer)

________________________________ ________________________________