PBR - Hot Work Permit

Date *

Location/Building & Floor *

Work to be done *

Time Started *

Time Completed *

Hot Work by *

Employee

Contractor

Name (print) of Person doing hot work *

I verify that the above location has been examined *

Please Check off *

Available sprinklers, hose streams, and extinguishers are in service and operable

Hot work equipment is in good working condition in accordance with manufacturer's specifications.

Special permission obtained to conduct hot work on metal vessels or piping lined with rubber or plastic.

Requirements within 35 ft (11 m) of hot work *

Flammable liquid, dust, lint, and oily deposits removed.

Explosive atmosphere in area eliminated.

Floors swept clean and trash removed.

Combustible floors wet down or covered with damp sand or fire-resistive/noncombustible materials or equivalent.

Personnel protected from electrical shock when floors are wet.

Other combustible storage material removed or covered with listed or approved materials (welding pads, blankets, or curtains; fire-resistive tarpaulins), metal shields, or noncombustible materials.

All wall and floor openings covered.

Ducts and conveyors that might carry sparks to distant combustible material covered, protected, or shut down.

Requirements for hot work on walls, ceilings, or roofs *

Construction is noncombustible and without combustible coverings or insulation.

Combustible material on other side of walls, ceilings, or roofs is moved away.

Requirements for hot work on enclosed equipment *

Enclosed equipment is cleaned of all combustibles.

Containers are purged of flammable liquid/vapor.

Pressurized vessels, piping, and equipment removed from service, isolated, and vented.

Requirements for hot work fire watch and fire monitoring *

Fire watch is provided during and for a minimum of 1 hour after hot work, including any break activity.

Fire watch is provided with suitable extinguishers and, where practical, a charged small hose.

Fire watch is trained in use of equipment and in sounding alarm.

Fire watch can be required in adjoining areas, above and below.

Yes

No - Per the PAI/fire watch, monitoring of hot work area has been extended beyond 1 hour.

Confirmation *

I Confirm all information is Accurate and Up to Date

Digital Initial *