Hot Work Permit Rev 1

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HOT WORK PERMIT

Equipment Description: Hot Work Permit No: Description Of Hot Work: Accompanying PTW No: Hazard Type: Open Flame Spark Producing Acid Usage Flammable Release Fire Precautions: Fire Extinguisher (Type: ..............................................) Fire Hose and Nozzle Hose reel Fire Blanket Additional PPE,s Fixed Fire Protection System Disabled? Yes No Type Of Flammable Materials That May Be Present In Hot Work Area: Fuel Oil Lube Oil Others Flammable gas test frequency is set to every ......... minutes. (Please record readings on the reverse page.) Checklist Of Precautionary Actions By Working Party: Area designated and cordoned Clearing and binding Remove flammable materials Seal open drains and vents Remove combustible material Wet down area Make surrounding area safe Check other work in area Provide for overhead work Safe location of welding set Perform gas test Fire watch man Standard 0 - 10% LEL Initial reading: .............

This permit will automatically be revoked under the following conditions: 1. Safe condition ceases to exist.. 4. Working party fails to observe safety 2. Gas concentration above 10% LEL. precautions. 3. Plant shutdown shortened. 5. Absence of HW working party above 2 hours. The SCE/HSE has the right to revoke this Hot Work Permit at his discretion. Issued by (block letters): Signature: Date/Time:

I hereby declare that I understand the hazard that may be present in the designated hot work area and have taken all the necessary precautionary actions as specified prior to the signing of this Hot Work Permit. I understand my responsibility should a hazardous condition occur. Name (block letters): Signature: Date/Time:

CLEARANCE OF PERMIT (to be filled by the working party Competent Person) I hereby declare that all activities related to the hot work specified in this Hot Work Permit have been stopped and all equipment has been cleared. Name (block letters): Signature: Date/Time

THIS HOT WORK PERMIT IS HEREBY CANCELLED. Name : Signature: Date/Time

EXTENSION OF PERMIT (for longer than one shift) Extension is not granted Approval is granted for permit extension as below: Date Day Shift SSCE Sign Night Shift SSCE Sign.

THIS HOT WORK PERMIT MUST BE DISPLAYED AT THE DESIGNATED AREA WHILE HOT WORK IS BEING CARRIED OUT. Flammable Gas Monitoring Result: (Permit shall be revoked if > 10% LEL) Date/ Time % LEL Fire Watch Date/ Time % LEL Fire Watch Date/ Time % LEL Fire Watch

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