Hot Work Permit

Your Name:

Organization:

Outside Contractor Name (if applicable)

Location:

Room Number

Phone Number

- -

Work Summary:

Work Description:

Date of Hot Work

Work Order#:

(ex: 99-999999)

PPMR #:

(ex: 10350)

Hot Work Checklist

Please check all applicable precautions you've taken below:

General Hot Work Requirements:

Sprinklers and hose streams in service/operable.

Hot Work Equipment in good condition

Hot Work Equipment in good condition (e.g., power source, welding leads, torches, etc.)

Multi-purpose fire extinguisher

Multi-purpose fire extinguisher and/or water pump can.

Requirements Within 35 feet of work:

Dust, Lint, Debris, Flammable Liquids and oily deposits removed; floors swept clean.

Explosive atmosphere

Explosive atmosphere in area eliminated.

Combustible floors

Combustible floors (e.g., wood, tile, carpeting) wet down, covered with damp sand or fire blankets.

Remove flammable material

Remove flammable and combustible material where possible. Otherwise protect with fire blankets, guards, or metal shields.

All wall and floor openings covered

All wall and floor openings covered.

Walkways protected beneath hot work

Walkways protected beneath hot work.

Work on Walls or Ceilings:

Combustibles moved away from other side of wall.

Work in Confined Spaces:

Confined space cleaned of all combustibles (example: grease, oil, flammable vapors).

Containers purged of liquids/vapors.

Containers purged of flammable liquids/vapors.

Follow confined space guidelines.

Fire Watch/Hot Work Area Monitoring:

Fire watch will be provided during and for 30 minutes after work, including any coffee or lunch breaks.

Fire watch is supplied

Fire watch is supplied with an extinguisher, and/or water pump can, also making use of other extinguishers located throughout work area.

Fire watch is trained

Fire watch is trained in use of this equipment and familiar with location of sounding alarm.

Fire watch may be required

Fire watch may be required for opposite side of walls, above, and below floors and ceilings.

Other Precautions Taken:

Check Box

By checking this box, you certify that the above location has been examined, the precautions checked on the Hot Work Checklist have been taken to prevent fire, and by that acceptance, permission is authorized for this work by the University of Kansas.