ATTACHMENT C Forms.pdf

FORMS

HOT WORK PERMIT

NEEDED WHEN ANY SPARK OR HEAT PRODUCING EQUIPMENT IS TO BE USED

Project Name:

Name of Contractor’s Firm:

Contractor Contact Name:

Contractor Contact Telephone Number

Date:

Building/Location:

Work To Be Done:

Any Special Precautions:

Fire Watch Required: Yes No The location where the work is to be performed has been examined, necessary precautions have been taken, and permission is granted for this work.

Signed (Contractor Individual Responsible for Authorizing Hot Work)

Permit Expires: (Date)

Time Hot Work Started: Time Hot Work Completed:

FINAL CHECK-UP

Work area and all adjacent areas to which sparks and heat might have spread (including floors above and below and on opposite sides of walls) were inspected 30 minutes after the work was completed and were found fire safe.

Signed _ Contractor’s Fire Watch)

(Page 1 of 2)

Date _

ATTENTION

Before approving any cutting and welding permit, the contractor’s authorized representative or their appointee shall inspect the work area and confirm that precautions have been taken to prevent fire in accordance with NFPA Standard No. 51B.

PRECAUTIONS

• Sprinklers are in service where installed

• Cutting and welding equipment in good repair

• Within 35 feet; floors swept clean of combustible, no combustible material or flammable liquids, all wall and floor openings covered, and covers suspended beneath work to collect sparks

• When working on enclosed equipment and in confined space, equipment and area is free of flammable vapors

• Fire watch provided during and 30 minutes after operation (60 minutes for torch applied roofing operations)

• Portable fire extinguisher with adequate rating available in the immediate vicinity

• Standpipe system in service where installed

• Protection of any sprinkler heads when hot work is in close proximity

• Smoking prohibited in immediate vicinity

• Non-combustible shields provided when hot work is done near combustible walls, partitions, floors, roofs

• Prohibition of hot work on pipes contacting combustible walls

• Personnel trained in use of equipment including portable fire extinguishers and sounding a fire alarm

• Final check-up conducted after 30 minute

(Page 2 of 2)

DAILY INSPECTION FORM

INSTRUCTIONS: This form is to be utilized when hazards are posed by NFPA 101 deficiencies or construction activities are in progress. Remediation must be implemented upon project start and continuously enforced through project completion to provide a level of life safety comparable to that described in the Life Safety Code. Submit completed forms to the Contracting Officer.

Project Name: Project Number:

Construction & Impact Description: Construction Location:

Affected Areas:

Project COR: Project Start Date:

Project Competent Person (CP): Estimated Duration:

Completion Date:

Contractor:

GC Supervisor: Telephone:

Contractor CP:

Inspection Period:

Responses: SUN MON TUE WED THR FRI SAT

1. Are exits readily accessible and provide unobstructed egress?

2. Have alternate exits been established if required due to

3. If alternate exits have been established, are personnel in the area informed and aware of their relocation?

4. Are the existing and relocated exits clearly marked and able to be

5. Are evacuation routes posted with follow-up inspections required

6. Are written procedures and guidelines posted in the immediate and adjacent areas for what to do and who to call in the event of a fire

7. Are personnel in immediate/adjacent areas aware and informed in procedures and guidelines to follow in the event of fire

8. Is there free and unobstructed access to services for emergency personnel (eg, fire, medical, security)?

9. Are fire alarm (eg, pull station), detection (eg, smoke/heat), suppression (eg, sprinkler, extinguisher) systems in working

10. If the fire alarm, detection, suppression systems are impaired or temporarily non-functional, has a fire watch for the area, as required or necessary, been trained and established?

11. If the fire alarm, detection, suppression systems are impaired, have measures been taken to provide temporary equivalent equipment and/or systems for adequate protection? Note date for

12. If the fire alarm, detection, suppression systems are impaired, are equivalent equipment/systems inspected and tested

13. If temporary fire alarm, detection, suppression systems are installed, are personnel in the area aware and trained on how to operate or utilize them in the event of fire or emergency?

14. Has the “No Smoking” policy been posted, implemented and enforced in the construction area?

15. Are temporary partitions built to be fire/smoke tight with fire retardant noncombustible material and inspected daily for

16. Is construction site access restricted to authorized personnel only including warning signs and secured at the end of each

Inspection Period:

Responses:

SUN

MON

TUE

WED

THR

FRI

SAT

17. Is construction area hazard surveillance conducted daily?

18. Is construction area storage, waste, debris and excess materials being daily managed properly to reduce fire or safety

19. Are construction activities and materials prosecuted, handled, stored, and secured in an orderly and safe manner?

20. Is the generation, spread and exposure of construction dust, fumes, noise, odor, smoke controlled with appropriate fume, odor, vapor ventilation provided to control noxious, infectious, toxic exposure and store/protect flammable/combustible products?

21. Has a GC Safety Manager been designated with routine site safety meetings conducted to ensure awareness of Life Safety

22. Is personnel protective equipment (e.g., safety glasses, ear plugs, hard hats) required and being used?

23. If there are hand/safety rails, scaffolding or ladders required, are they in place, in good condition and being used in a

24. Are the construction site (buildings and exterior grounds) hazards (e.g., fall/trip) guarded and free of potential safety

25. Do electrical panels, temporary wiring, extension cords (3 wire grounded type), tools, and equipment appear to be installed, utilized, and functioning in a safe manner?

26. If there are temporary electrical outlets provided, do they have ground fault protection at the receptacle/panel?

27. If hazardous equipment/systems need to be de-energized, are applicable “Lockout/Tagout” procedures being followed?

28. Are utility services (e.g., electrical, steam, water, waste, gas) properly secured at the end of each day?

29. If there is any hot work (welding, soldering, cutting) being performed within the construction site, have additional fire safety precautions been taken and necessary equipment provided?

30. If there is any hot work (welding, soldering, cutting) being performed on the construction site, has Contracting Officer been notified? Has the Hot Work Permit been approved?

31. If hazardous products are present, are they limited to the amount needed and used daily?

32. Are hazardous products disposed according to EPA

33. Are all hazardous products present or being used (e.g., flammable, combustible, corrosive, noxious) labeled with MSDS information readily available?

34. If infection control is required, are the appropriate policies and procedures known and being followed?

35. Are all safety incidents documented and reported to the Contracting Officer?

Contractor CP Initials Performing Daily Inspections:

Inspection Comments/Findings: (PROVIDE DETAILED EXPLAINATION OF

EXCEPTIONS/DEFICIENTIES)

Signature/Date:

Project CP GC Safety Manager