6. VALBMC Hot Work Permit.pdf

VA Long Beach Healthcare System (VALBHS)

Hot Work Permit

This permit requests must be submitted through the Fire & Life Safety PM, or Safety designee; 48 working hours in advance, before the start of any work. For emergency permit requests, call (562)826‐8000 or ext. 3153.

Contact: VALBMC FLS PM Page 1 of 2 Form – FLS 4 (562)676-2236 or Ext. 3153 Rev: Sept. 2019 By: MB

Acknowledgments/Approvals (print, sign, date):

General Contractor (GC): _________________________________________________ Date: __________________

*By signing, signee acknowledges and is responsible for compliance with OSHA, IBR CONCENSUS STANDARDS and VHA requirement, for all work processes performed to support hot work; while at VALBMC. Signee has read and understood reverse page information this permit.

1. Approved Disapproved : ________________________________________________ Date: __________________

(Project Engineer: COR)

2. Approved Disapproved : _______________________________________________ Date: __________________

(Section Chief/Shop Supervisor or RE)

3. Approved Disapproved : _______________________________________________ Date: __________________

(Life Safety Officer)

4. Permit Expiration Date: _____________________________________________ Time: ________________ (Life Safety Officer)

5. Quality Assurance: __________________________________________________________ Date: __________________

*Inspection of: 1.) completed hot work and 2.) Immediate/adjacent hot work areas.

(GC & COR)

Govt. Requestor: Date of Request:

COR/Requester’s HCG/Shop: Phone#:

Est. start of work – Date: Time: Est. Compl. of work ‐Date: Time:

A. AFFECTED WORK AREA

Building(s) #: HCG/Service/Clinic:

Floor(s): Room(s)#: Other:

Scope of work to be performed:

B. PROVISIONS

Fire Watch Required? YES NO Is there an active ILSM Fire Watch (if Yes, fire watch must be performed every hour and 30 minutes after task is completed. Must use VALBHC Fire Watch Action/Log att. B to document.)

Will this work result in fire/smoke wall, floor, or ceiling penetrations? YES NO If yes, complete the corresponding Above the Ceiling/Penetration Permit, and ICRA.

Prior to requesting hot work permit:

The designated competent person or M&O Supervisor has conducted a pre‐inspection of equipment, site and ensured workers performing the hot work/fire watch, are properly trained. YES NO

Before the start & During any hot work process:

The designated competent person or M&O Supervisor shall inspect the work area and confirm all precautionary measures are in place; to prevent IIP and fire: IAW with OSHA and NFPA 51B/241, etc. ACKNOWLEDGED (see reverse of permit)

Actual Start of work ‐ Date: Time: Actual Compl. of work ‐ Date: Time:

GC Supervisor Phone#: 24‐HR Emergency Phone#:

VA Long Beach Healthcare System (VALBHS)

Hot Work Permit

This permit requests must be submitted through the Fire & Life Safety PM, or Safety designee; 48 working hours in advance, before the start of any work. For emergency permit requests, call (562)826‐8000 or ext. 3153.

Contact: VALBMC FLS PM Page 2 of 2 Form – FLS 4 (562)676-2236 or Ext. 3153 Rev: Sept. 2019 By: MB

The VALBMC expectation is full cooperation in complying with our efforts to maintain optimal life safety condition. To mitigate potential ignition sources, or factors that may contribute to the development or spread of fire; throughout our facility. Providing a safe environment for our: a. patients, b. staff, c. students, and d. visitors.

I. General contractors, vendors and VA staff performing short/long term work, that requires aspects of permit, at the VA

Long Beach Healthcare System shall:

1) Obtain fully approved Hot Work Permit; prior to the commencement of any work.

2) Requests must be submitted 48 working hours prior to the start of any work. Permits are valid for 24 hours. On a case‐by‐case basis, the maximum length of any permit is 1 working week.

3) Must specifically include all work areas affected and thorough scope of work, for operation.

4) Ensure a copy of valid permits, are conspicuously posted at all work location; and readily available for inspection/verification, upon request.

5) Upon completion of hot work and after CG/COR’s final Q&A inspection. Permit is to be returned to the Safety

Service’s Fire and Life Safety PM to be filed: a.). Permit, b. JSA c. SDS/MFG. Specifications (where applicable).

II. COMPLIANCE PRECAUTIONS: 1.) All Hot work processes are subject to applicable general safety, local policies & federal standards; and related environmental responsibility. 2.) Control, maintain and assure permanent record of any hot work operations. 3.) Ensure general safety precautions are addressed, such as, but not limited to:

PRECAUTIONS:

Sprinkler in service (or appropriate measure in place/ILSM).

Cutting and welding equipment maintained in approved manufacturing operating condition.

Utilities properly secured (ex: oxygen, LP gas, etc.).

LOTO, energy controls as appropriate.

PPE (ex: FR rated, eye light shielding, respirator, etc.).

Requestor and applicable GC conforms to VALBMC policies and procedures.

Contractors are responsible for maintaining their own company policy(s), for all work processes to support hot work; and provide the FLSPM with a copy of each.

WITHIN 35 FT. OF HOT WORK:

Floor swept clean of combustibles.

Combustible materials or flammable liquid.

NO combustible materials or flammable liquids.

Combustibles and flammable liquids protected with approved covers, guards, shielding and lockers.

ALL wall and floor openings covered.

WORK ON WALLS OR CEILINGS:

Covers suspended beneath work to collect sparks.

Construction noncombustible and without combustible coverings.

Any fire wall, ceiling, door penetrations shall be sealed with approved rated materials.

Comply and file VALBMC: Above the Ceiling & Penetration Permit.

WORK ON ENCLOSED EQUIPMENT (TANKS, CONTAINERS, DUCTS, BOILERS, ETC.)

Combustibles moved away from the opposite side of walls.

Equipment cleaned of all combustibles.

Containers purged of flammable vapors.

Contractors are responsible for implementing all aspects of permit‐required confined space program. To include: air monitoring, rescue, fall protection, etc.

FIRE WATCH (where applicable)

Have available approved fire extinguisher on work site. Trained in the use of the equipment, documentation using VALBHC Fire Watch Action/Log attachment B of ILMS HSP; and ability to in sounding the fire alarm.

FIRE & SMOKE ALARM SYSTEMS

Before any life safety impairments, ensure ILSM process HSP 003‐14 is adhered to, and adequate pre‐coordination with stakeholders to support any shut down requests or life safety deficiency; is afforded.

III. General contractor scope of work shall include job specific Job Safety Analysis (JSA), to mitigate and address identified risk (ex: PACM, ILSM, Fall Protection, Electrical Safety, etc.). Attach JSA to permit request for VALBMC Fire & Life Safety Program Managers review.

IV. 1.) Requestor ACKNOWLEDGE ALL (I, II, III): 2.) G.C. ACKNOWLEDGE ALL (I, II, III):