Work to be performed by: *
Work to be performed by:
Employee
Contractor
Date
Date *
/
MM
/
DD
YYYY
LOCATION OF WORK (BUILDING/FLOOR/OBJECT) *
WORK TO BE PERFORMED *
NAME OF PERSON PERFORMING HOT WORK *
NAME OF PERSON PERFORMING FIRE WATCH
By entering my name below, I verify the above location has been examined, the required precautions have been taken, and permission is authorized for this work. *
Required Precautions
Please check appropriate boxes below - Contact Control Center or Risk Management & Safety with any questions concerning fire protection equipment.
You certify that you have called the Control Center to verify that the fire alarm and sprinkler system in the building in which work is to be performed is functional. *
You certify that you have called the Control Center to verify that the fire alarm and sprinkler system in the building in which work is to be performed is functional.
Yes
No
Extinguishers are in service/operable. *
Extinguishers are in service/operable.
Yes
No
Requirements within 35 feet
Shield combustible construction and/or combustibles using appropriate fire resistant welding pads, blankets or curtains. *
Shield combustible construction and/or combustibles using appropriate fire resistant welding pads, blankets or curtains.
Yes
No
N/A
Isolate or remove potential sources of flammable gas/liquid/dust. *
Isolate or remove potential sources of flammable gas/liquid/dust.
Yes
No
N/A
Shut down ventilation *
Shut down ventilation
Yes
No
N/A
Consider second fire watch on opposite side of floor, wall, ceiling or roof when openings exist or thermally conductive materials pass through. *
Consider second fire watch on opposite side of floor, wall, ceiling or roof when openings exist or thermally conductive materials pass through.
Yes
No
N/A
Is work on a combustible building assembly or component (example - torch-applied roofing)? If yes, please provide additional required precautions below. *
Is work on a combustible building assembly or component (example - torch-applied roofing)? If yes, please provide additional required precautions below.
Yes
No
Hot work on/in closed equipment, ductwork or piping
Isolate equipment from service. *
Isolate equipment from service.
Yes
No
N/A
Remove ignitable liquid and purge flammable gas/vapor. *
Remove ignitable liquid and purge flammable gas/vapor.
Yes
No
N/A
Prior to work, and/or during work, monitor for flammable gas/vapor. *
Prior to work, and/or during work, monitor for flammable gas/vapor.
Yes
No
N/A
Remove combustible dust/lint or other combustible materials. *
Remove combustible dust/lint or other combustible materials.
Yes
No
N/A
Is work on/in equipment with nonremovable combustible linings or
parts? If yes, provide additional required precautions below. *
Is work on/in equipment with nonremovable combustible linings or
parts? If yes, provide additional required precautions below.
Yes
No
N/A
Fire watch/Fire monitoring the hot work area
Perform continuous fire watch during hot work *
Perform continuous fire watch during hot work
Yes
No
Perform fire watch post work for minimum of 1 hour. If circumstances dictate longer, please provide additional required precautions below *
Perform fire watch post work for minimum of 1 hour. If circumstances dictate longer, please provide additional required precautions below
Yes
No
Perform post work fire monitoring for minimum of 3 hours. If circumstances dictate longer, please provide additional required precautions below *
Perform post work fire monitoring for minimum of 3 hours. If circumstances dictate longer, please provide additional required precautions below
Yes
No
Additional required precautions - please list below