Hot Work Permit - SAF 019

THIS HOT WORK PERMIT SHALL BE VALID FOR TWENTY-FOUR (24) HOUR PERIOD PER TASK
WITH THE OPTION OF EXTENSION UNTIL COMPLETION
Worksite: Date of issue: Permit no.:
Contractors name: Contractors Address:

Contractors responsible person: (For performing the work specified for duration of this permit)

Description of work: Sketch of exact location:

Special instructions:

Hot Work Performed:

Location/Building:
Authorized duration of Permit (Number of days)
Date: to
Time: to
Any substances SHE Specifications met? Airside Permit issued: Approved
hazardous to health? Contractor:
Yes No Yes No Yes No Yes No
Number:
PERSONAL PROTECTIVE REQUIREMENTS (TICK WHICH SHALL BE ISSUED)
EYES HAND EARS BREATHING BODY - OTHER
Goggles PVC Gloves Ear Protection Canister Mask Safety Harness
Shield Ordinary Gloves Air Supplied Rubber Boots
Respirator
PVC Suit
TYPES OF EQUIPMENT/TOOLS USED (TICK APPLICABLE)
Acetylene Torch Abrasive Saw Electric Saw Electric Tools
Heliarc Welding Propane Torch Drilling Other (List)
Provide Description of equipment / tools:

STANDARD CONDITIONS YES NO

Issue: 2 Issue Date: 22nd July 2015
Page: 1
EXCAVATIONS: When more than 1.5m deep the following conditions shall apply before
work is permitted
1) Are the sides of the excavations e suitably shored and graded back
WELDING 1) Is equipment sited in an approved safe area?
EQUIPMENT: 2) Are welding cables in a good condition?
3) Is there an insulating bridge in place where cables cross pipelines?
4) Is the welding circuit cable positioned within two (2) meters of the
job? (NOTE: Earth routing via installed plant is prohibited)
FLAME CUTTING 1) Is the equipment in a safe area?
EQUIPMENT: 2) Are oxy/acetylene cylinders secured upright in a special trolley rack?
3) Confirm flashback arrester fitted
Gas cylinders MUST NOT be taken inside tanks or confined spaces and
when not in use MUST be turned off at the main cylinder valve
HAZARDOUS 1) Is Hot Work kept free of loose flammable and combustible materials
MATERIAL: and empty drums? If not, confirm appropriate action taken?
2) Where asbestos, lead or other critical materials are present in the
work area, the appropriate Statutory Regulations and Codes of
Practice must be strictly observed. Is Contractor/Employee familiar
with these requirements?
3) Are hazardous material transfers disconnected within twenty-one (21)
meters of Hot Work?
4) Is the location of hazardous material spill equipment known by
Contractor/Employee?
5) Are control measures available for hazardous material spillages?
COMPRESSORS The compressor should be sited upwind of the job in an approved safe
FOR BREATHING area free from flammable and toxic vapours. Confirm if a wind sock is in
EQUIPMENT: place.
WETTING During hot work, chipping, caulking or grinding and disk cutting of
EQUIPMENT: materials, concrete or other materials likely to cause a hazardous build-
up of temperature, provision must be made for thoroughly wetting the
work being carried out. Is coolant available?
HOUSEKEEPING: 1) Are floors swept clean of combustibles?
2) Are remaining combustible or flammable materials ten (10) meters
horizontally as well as vertically away from source of heat?
3) Are vessels, equipment drained, purged, ventilated and cleaned?
4) Is an inert gas blanket required?
5) Is welding, cutting fume ventilation or respirator required?
6) Is building/area air currents and outdoor wind direction known?
7) Is appropriate signage in place to display danger or warnings of Hot
Work in progress?

Issue: 2 Issue Date: 22nd July 2015

Page: 2
DRAINS: Are all drains within fifteen (15) meters of hot work must be covered with
a tarpaulin or heavy gauge plastic and sanded? Confirm drains are
sealed.
FIRE 1) Are at least two (2) fire extinguishers, suitable for the job, made
EXTINGUISHER: available at the work site? Confirm if fire extinguishers are available.
2) Is fire protection equipment available and operational?
FIRE 1) Is there an automated fire sprinkler system in place?
PREVENTION 2) Is the automated fire sprinkler system operational?
SYSTEMS:
VENTILATION: Are vertical and horizontal openings within ten (10) meters sealed or
covered for spark or vapour control?
GAS FREE Before hot work can commence the work site must be certified gas free.
CERTIFICATION: Confirm certificate has been issued.
CONFINED A Safe Work Procedure shall be presented before any work shall be
SPACE: permitted in a confined space. Confirm if a Safe Work Procedure for work
in a confined space has been presented.
MAINTENANCE: Has a lock out/tag out of electrical, mechanical, chemical, blanking, cap
piping been implemented?
GENERAL: 1) Has a Security Permit been obtained when Hot Work is scheduled to
be completed in restricted areas?
2) Has the Site Supervisor been notified of work location and time of
operation?
3) Have involved persons and contractor employees been notified of
hazards?
4) Have involved persons and contractor employees been notified of
emergency evacuation and means of egress?
5) Has the environment been evaluated for levels of oxygen?
6) Is there a system to continuously monitor atmospheric conditions?
7) Is there a means to check for flammable/combustible gas and oxygen
levels?
8) Will a fire watch be provided during work and thirty (30) minutes after
the completion of work?
9) Will work areas and adjacent areas where sparks my have spread
checked thirty (30) minutes after work will be completed?

STANDARD CONDITIONS SPECIFIC CONDITIONS

The standard conditions set out above to be observed In addition to the general work permit specific
for: conditions, the following shall apply before work
(TICK IF NOT APPLICABLE) has commenced (Tick Appropriate Block) If Yes
is indicated, the specific conditions MUST be
written
1) Excavations N/A Gas freed or purged

Issue: 2 Issue Date: 22nd July 2015

Page: 3
 2) Welding equipment N/A 1) By ventilation YES NO
3) Flame cutting equipment N/A 2) By water flushing YES NO
4) Hazardous materials N/A 3) By steaming YES NO
5) Compressors for breathing equipment N/A 4) By nitrogen YES NO
6) Housekeeping N/A 5) By pigging YES NO
7) Wetting Equipment N/A
8) Drains N/A Gas freed Certification Number:
9) Fire extinguishers N/A
10) Fire Prevention Systems N/A Other Conditions:
11) Ventilation N/A
12) Gas free certification N/A
13) Entry permit N/A
14) General N/A
RE-ENDORSEMENT OF PERMIT TO BE BY: RE-ENDORSEMENT OF PERMIT TO BE BY:

DAILY/HOURLY DAILY/HOURLY
AUTHORIZATION TO CARRY OUT HOT WORK
ISSUED BY:
1. Safety Officer/Fire & Rescue Controller (Print Name):
Valid from……………….. am to
……………………………am/pm
2. Other responsible person (Print Name):
Valid from……………….. am to
……………………………am/pm
I UNDERSTAND THE NATURE OF THE WORK AND CERTIFY THAT THE ABOVE CONDITIONS WILL BE
OBSERVED AT ALL TIMES

RECEIVED BY CONTRACTOR/EMPLOYEE ………………/………………/………………

WORK COMPLETED WORK HANDED BACK

Received by Safety Manager/Fire & Rescue Manager
Contractor/employer (Print Name and Signature): (Print Name and Signature):

Date: Date:
Time: Time:
THIS PERMIT IS RENEWED THIS HAS PERSONALLY BEEN CHECKED BY THE
FROM TO UNDERSIGNED. THE CONDITIONS LISTED HAVE
NOT CHANGED AND IT IS CONSIDERED SAFE FOR
WORK TO COMMENCE

Issue: 2 Issue Date: 22nd July 2015

Page: 4
DISPLAY OF PERMIT
THIS PERMIT SHALL BE CLEARLY DISPLAYED AT THE WORK SITE WITH CONTRACTOR/EMPLOYEE
PERFORMING THE WORK
PERMIT ISSUE
▪ Permits are to be issued by Safety Officer or Fire and Rescue Controller or the designated person.
▪ This permit is valid as long as work conditions existing at the time of issuance continue. It expires on any
change of condition that adversely affects safety of the work area while work is in progress.
▪ Upon completion of work and acceptance the Contractor/Employee shall sign and hand back the permit
to the Safety or Fire and Rescue Manager for close-out.
▪ A copy to be given by hand to the Site Manager and a copy to be kept by the person issuing the permit.
The location, where the above work is to be done has been inspected, check for compliance with the safety
precautions identified on the Hot Work Permit
WORK SHALL BE STOPPED IMMEDIATELY IF THE EMERGENCY ALARM SIGNALS AN EMERGENCY
IN OR NEAR YOUR WORK AREA. FOLLOW THE INSTRUCTIONS OF THE EVACUATION WARDEN
THE FOLLOWING PERSONS SHALL CERTIFY THAT THE ABOVE EQUIPMENT/SITE IS SAFE TO
CARRY OUT HOT WORK BY PERSONS SUBJECT TO THE SPECIFIED REQUIREMENTS
TITLE: NAME (PRINT NAME): SIGNATURE: DATE:
Originator:
Safety Representative:
Welder:
Fire Watch:
Contractor/Person Responsible for work
Works areas and adjacent areas where sparks may have spread are checked out 30 minutes after work.
CONTACTOR /COMPANY: NAME (PRINT NAME): SIGNATURE: DATE:

Final sign off by

Safety/ARFF after
inspection
representative
NAME (PRINT NAME): SIGNATURE: DATE:
Safety Officer
ARFF representative

Issue: 2 Issue Date: 22nd July 2015

Page: 5