Docstoc

Hot Work Permit Hot Work Permit Application for Work Contractor Permi

Document Sample
Hot Work Permit Hot Work Permit Application for Work Contractor Permi Powered By Docstoc
					                                                    Hot Work Permit
               Application for Work

               Contractor:                                                             Permit to work No.:
               Organisation:                                                           Contact No:
               Location of Work:                                                       Job Identification No.:
               Description of Work:

               Permit Duration
               Permit Commences:                                               Permit Expires:
               Date: / /     Time:             am/pm                           Date: / /       Time:           am/pm

               Safety Information
               □ Equipment to be used:
               □ Fire Watch Required:
               □ Isolation Required:
               If a fire occurs, call………………………………………( ) Tel………………………………
               Nearest fire alarm:……………………………………………………………………………….

               Site Representative Approval
               The above work is authorised to proceed subject to the following action being taken prior to work commencing and
               procedures being maintained for the duration of the work. Each item is to be checked by the Authorised Company
               Representative prior to work starting for each period (delete and initial if and where Not Applicable).

               Authorised by:                                        Signed:                                           Date:       / /


               1      Fire Sprinklers and/or Thermal Detectors         □   6      Combustible materials located within 10 m          □
                      must be confirmed as operational (where                     must be removed or protected with non-
                      installed).                                                 combustible curtains, metal guards or flame
                                                                                  proof covers (not ordinary tarpaulins). In a
                                                                                  retail/office environment if 10m clearance is
                                                                                  not practical then the largest distance
                                                                                  possible (min 3m) is acceptable.
               2      Smoke Detection must be isolated in the          □   7      All floor & wall openings within 10m must be       □
                      area and Impairment Procedures followed.                    covered to prevent transmission of sparks.

               3      Fire equipment to be provided as follows:        □   8      The hot work area and any adjoining areas          □
                      □ Fire Hose Reel                                            must be patrolled from the start of work until
                                                                                  60 minutes after the work is completed
                      □ Fire Extinguisher
                                                                                  (including break periods).
                      □ Mandatory Fire watcher present.

               4      Barricades, warning signs and spark/flash        □   9      Special details. (Please detail.)                  □
                      screens must be provided.

               5      Work areas, trenches, pits etc must be clear     □   10     Other:                                             □
                      of flammable liquids, gases or vapours.




               Site Representative Final Check - Work Completed and Area Safe
               The work area and all adjacent areas have been checked and hazards associated with the
               permit conditions have been satisfactorily addressed and systems recommissioned.

               Authorised by:                                                          Date:

               Signed:




This document is intended to assist a client of VMIA with risk management activities. This document should not be relied on as professional advice.

				
DOCUMENT INFO
Shared By:
Categories:
Tags: Work, Permit
Stats:
views:232
posted:3/12/2010
language:English
pages:1
Description: Hot Work Permit