Hot Work Permit
表格 - Version 2
Hot Work Permit · FORM-30117
Site and work details
- Site Name:
- —
- Site Location:
- —
- Location of Hot Work:
- —
- Date Permit Starts:
- —
- Time (Permit Starts) am / pm:
- —
- Date Permit Expires:
- —
- Time (Permit Expires) am / pm:
- —
- Description of work:
- —
To be completed by the person performing the work
- Company Name:
- —
- Contractor / Worker Name:
- —
- Contact address:
- —
- Phone:
- —
- Supervisor Name:
- —
- Phone (Supervisor):
- —
To be completed by the approved person in consultation with the worker/s performing the work
Equipment
Emergency information
- Closest Emergency Alarm is located at:
- —
- Closest Evacuation Assembly point is:
- —
- Supervisor to be notified is:
- —
- Phone Number:
- —
Control measures
Services isolated
Hot work location has been isolated from
General
Environmental conditions are assessed
Spotter / fire watch
Within 10 metres of work area
Pre-work questions
Applicant agreement
- Name:
- —
- Signature:
- —
- Date & time:
- —
Authorisation by approved person
- Name:
- —
- Signature:
- —
- Date & time:
- —
Final sign-off by approved person
- Name:
- —
- Signature:
- —
- Date & time:
- —
Hot Work Permit · FORM-30117
