Post Permit at Hot Work Location

HOT WORK PERMIT

Facility: Hot Work Work Order No. (not required):
Location:
Description of Work (material and equipment): Permit Issued (date/time): Permit Expires (date/time):

PSM Hot Work: Yes No Torch-Applied Roofing Project: Yes No

If yes, route completed permit to PSM Coordinator to file. If yes, conduct TAR Project Preconstruction Meeting with Contractor.
Permit required for work involving open flames, heat, hot slag or sparks. Issue Permit only if no acceptable alternatives to hot work exist.
Examples of hot work include: burning, cutting, welding, brazing, soldering, grinding, thawing pipe and torch applied roofing projects.
Yes N/A General Required Precautions for all Hot Work
Sprinklers and/or fire detection systems are operating properly.
Hot work equipment is in good working condition.
Proper fire extinguisher(s) present. Check required type(s): A BC ABC CO2 Other:
Hot Work Operator(s) trained in hot work procedures and gas cylinder safety.
Fire Watch(s) trained in fire watch procedure, fire extinguisher use and sounding fire alarm system.
Yes N/A Additional Precautions Required within 35 feet of all Hot Work
Equipment and floor is clean of combustible materials and there is no hazardous atmosphere.
Combustible materials and flammable liquids have been removed or protected (using fireproof tarps, shields, etc.).
All wall and floor openings, ducts and conveyors that might carry hot slag or sparks to combustible material are covered or closed.
Team Members have been notified that hot work will occur and have been protected, if necessary, using screens, barricades, etc.
Combustible belting has been removed or protected (using fireproof tarps, shields, etc.).
Combustible floors have been wetted, covered with damp sand, metal or fireproof tarps.
Steel members, pipes, etc. that could transmit heat to combustibles are identified and protected, if necessary, using fireproof tarps, etc.
Yes N/A Additional Precautions for Hot Work on or near Walls, Ceilings or Roofs
Combustible materials have been removed from opposite side of walls, ceilings or roofs where hot work will be performed.
Identified hazards of performing hot work near walls, partitions, ceilings, roofs and protected with fireproof tarps or shields as necessary, etc.
Yes N/A Additional Precautions for Hot Work on Enclosed Equipment (tanks, containers, ducts, conveyors, etc.)
Equipment cleaned of combustibles.
Equipment purged of flammable liquids and explosive vapors.
Inlets and outlets closed and locked out as necessary.
Yes N/A Fire Watch Requirements
Perform fire watch on both sides of wall or ceiling.
Perform continuous fire watch during hot work.
After hot work is completed, perform continuous fire watch for 1 hour and then periodic checks every ½ hour for 1 hour.
After torch-applied roofing hot work is completed, perform continuous fire watch for 1 hour and then periodic checks every ½ hour for 3 hrs.
Monitor area with Thermal Infrared Camera. [Required for torch-applied roofing projects and areas difficult to visually monitor for hot spots
(examples: on or near walls, ceilings, roofs, Interlox/plastic belts, and pipes, ducts, conveyors, structures that could transfer heat or sparks].
Permit Authorization
I inspected the work area, selected the required precautions, verified the precautions were in place and authorized this permit.
___________________________________ ________________________________ ________________________
Permit Authorizer Printed Name Permit Authorizer Signature Date
___________________________________ ________________________________ ________________________
Additional Permit Authorizer Printed Name* Additional Permit Authorizer Signature* Date
* Only required for torch-applied roofing projects

PERMIT AUTHORIZER TO KEEP TOP COPY OF PERMIT UNTIL

COMPLETED BOTTOM COPY IS RECEIVED

Tyson Form 16147 Rev. 1/9/2015 Page 1 of 2

 Post Permit at Hot Work Location
HOT WORK PERMIT
Facility: Hot Work Work Order No. (not required):
Location:
Description of Work (material and equipment): Permit Issued (date/time): Permit Expires (date/time):

PSM Hot Work: Yes No Torch-Applied Roofing Project: Yes No

If yes, route completed permit to PSM Coordinator to file. If yes, conduct TAR Project Preconstruction Meeting with Contractor.
Permit required for work involving open flames, heat, hot slag or sparks. Issue Permit only if no acceptable alternatives to hot work exist.
Examples of hot work include: burning, cutting, welding, brazing, soldering, grinding, thawing pipe and torch applied roofing projects.
Yes N/A General Required Precautions for all Hot Work
Sprinklers and/or fire detection systems are operating properly.
Hot work equipment is in good working condition.
Proper fire extinguisher(s) present. Check required type(s): A BC ABC CO2 Other:
Hot Work Operator(s) trained in hot work procedures and gas cylinder safety.
Fire Watch(s) trained in fire watch procedure, fire extinguisher use and sounding fire alarm system.
Yes N/A Additional Precautions Required within 35 feet of all Hot Work
Equipment and floor is clean of combustible materials and there is no hazardous atmosphere.
Combustible materials and flammable liquids have been removed or protected (using fireproof tarps, shields, etc.).
All wall and floor openings, ducts and conveyors that might carry hot slag or sparks to combustible material are covered or closed.
Team Members have been notified that hot work will occur and have been protected, if necessary, using screens, barricades, etc.
Combustible belting has been removed or protected (using fireproof tarps, shields, etc.).
Combustible floors have been wetted, covered with damp sand, metal or fireproof tarps.
Steel members, pipes, etc. that could transmit heat to combustibles are identified and protected, if necessary, using fireproof tarps, etc.
Yes N/A Additional Precautions for Hot Work on or near Walls, Ceilings or Roofs
Combustible materials have been removed from opposite side of walls, ceilings or roofs where hot work will be performed.
Identified hazards of performing hot work near walls, partitions, ceilings, roofs and protected with fireproof tarps or shields as necessary, etc.
Yes N/A Additional Precautions for Hot Work on Enclosed Equipment (tanks, containers, ducts, conveyors, etc.)
Equipment cleaned of combustibles.
Equipment purged of flammable liquids and explosive vapors.
Inlets and outlets closed and locked out as necessary.
Yes N/A Fire Watch Requirements
Perform fire watch on both sides of wall or ceiling.
Perform continuous fire watch during hot work.
After hot work is completed, perform continuous fire watch for 1 hour and then periodic checks every ½ hour for 1 hour.
After torch-applied roofing hot work is completed, perform continuous fire watch for 1 hour and then periodic checks every ½ hour for 3 hrs.
Monitor area with Thermal Infrared Camera. [Required for torch-applied roofing projects and areas difficult to visually monitor for hot spots
(examples: on or near walls, ceilings, roofs, Interlox/plastic belts, and pipes, ducts, conveyors, structures that could transfer heat or sparks].
Permit Authorization
I inspected the work area, selected the required precautions, verified the precautions were in place and authorized this permit.
___________________________________ ________________________________ ________________________
Permit Authorizer Printed Name Permit Authorizer Signature Date
___________________________________ ________________________________ ________________________
Additional Permit Authorizer Printed Name* Additional Permit Authorizer Signature* Date
* Only required for torch-applied roofing projects
Hot Work Operator (If more than one, the Lead Hot Work Operator must sign. Must not be the Permit Authorizer.)
Hot Work performed by: Tyson Team Member(s) Contractor Company Name (if Contractor):
I inspected the hot work area and certify the required precautions are in place and will remain in place during hot work activities.
___________________________________ ________________________________ ________________________
Hot Work Operator Printed Name Hot Work Operator Signature Date
Fire Watch (Must not be the Hot Work Operator)
Hot Work Started (date/time): Hot Work Completed (date/time):
Initial the Performed Performed Continuous Performed Periodic Fire
Extended Fire Watch Required
Completion of Continuous Fire Fire Watch after Watch After
for Torch-Applied Roofing Hot Work
each Required Watch During Hot Work Completion Hot Work Completion
Fire Watch Hot Work 1 hr. 1½ hr. 2 hr. 2½ hr. 3 hr. 3½ hr. 4 hr.
Interval:
Performed monitoring using a Thermal Infrared Camera: Yes No If yes, final thermal image taken at (date/time):
Fire Watch performed by: Team Member Contractor Company Name (if Contractor):
I performed fire watch duties as required. I certify my records are true and accurate. [Return completed form to Permit Authorizer within 24 hrs.]
___________________________________ ________________________________ ________________________
Fire Watch Printed Name Fire Watch Signature Date
Permit Review and Closure
Following Hot Work and Fire Watch, I reviewed this Permit for completeness. Corrective actions, if required, were addressed as necessary
[File non PSM-related Hot Work Permits for 3 months. If PSM-related, route to the PSM Coordinator to file per PSM Record Retention requirements.]
___________________________________ ________________________________ ________________________
Permit Authorizer Printed Name Permit Authorizer Signature Date

Tyson Form 16147 Rev. 1/9/2015 Page 2 of 2