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UTMB HOT WORK PERMIT
BEFORE INITIATING HOT WORK, ENSURE PRECAUTIONS ARE IN PLACE! THE CORRECT FIRE EXTINGUISHER MUST BE READILY AVAILABLE! This Hot Work Permit is required for all operations involving open flames or producing heat and/or sparks, including: Brazing, Cutting, Grinding, Soldering, Thawing Pipe, and all Welding. |
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INSTRUCTIONS |
REQUIRED PRECAUTIONS CHECKLIST q Available sprinklers, hose streams, and extinguishers are in service/operable. q Hot Work equipment is in good repair-torches have flashback arrestors at gauges. Requirements within 35 feet: q Flammable liquids, dusts, lint and oil deposits removed. q Explosive atmosphere in area eliminated. q Floors swept clean. q Combustible floors wet down, covered with damp sand or fire resistant sheet. q Remove other combustibles where possible. Otherwise protect with fire-resistant tarpaulins or metal shields. q All wall and floor openings covered. q Fire resistant tarps used where needed. Work on walls or ceilings/enclosed equipment: q Construction in noncombustible and without combustible insulation or covering. q Combustibles on other side of wall are move away. q No danger exists by conduction of heat into another area. q Enclosed equipment cleaned of all combustibles. q Containers purged of flammable liquids/vapors. Fire Watch/hot work area monitoring: q Fire Watch will be provided during and for ______hours after work, including any coffee or lunch breaks. q Fire Watch is supplied with suitable fire extinguishers. q Fire Watch is trained in the use of extinguishers and sounding alarm. q Fire Watch may be required for adjoining areas and below. Other precautions taken: q Confined space entry permit required. q Area protected with smoke or heat detection. q Ample ventilation to remove smoke from area. q Lock-out/Tag-out required.
CAMPUS EMERGENCY PHONE 2-1211
Comments:
*List additional Persons Doing Work and their signature on the back of the permit. |
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A. Verify precautions listed at right (or stop work) B. Finish filling out this permit and obtain the required signatures |
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REQUESTED BY: RequestorName |
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HOT WORK PERFORMED BY: TypeEmployee |
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DATE ISSUED: DateIssued |
DATE TO EXPIRE: DateToExpire |
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DATE UPDATED: |
SIGNATURE OF PAI: |
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JOB NO: JobNumber |
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BUILDING: Building |
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FLOOR: Floor |
ROOM: Room |
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Description of Hot Work: Description |
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The persons below affirm that the location has been examined, the precautions checked on the checklist have been taken to prevent fire and permission has been authorized for work. |
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PERMIT AUTHORIZING INDIVIDUAL (PAI) -Print Name
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PAI SIGNATURE
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SUPERVISOR OVER WORK - Print Name
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SUPERVISOR OVER WORK SIGNATURE
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PERSON DOING WORK - Print Name
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PERSON DOING WORK SIGNATURE
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