ATTACHMENT E Hot Work Permit (Daily) NEW.pdf

HOT WORK PERMIT - PART A

SI Tracking Number (by PAI)

Sprinklers and hose stations in service/operable.

Portable fire extinguisher available.

All wall and floor openings covered.

Walkways below hot work area protected.

Construction is noncombustible or protected.

No risk of heat conduction into another room/area, or second fire watch required for that space.

Enclosed equipment cleared of all combustibles.

Ye s

N

/A GENERAL PRECAUTIONS

Requested Permit Start: Date

Facility

Hot Work Type

Building Description of Work

Nearest phone identified.

Nearest fire alarm pull station identified.

Emergency Request (< 48hrs notice).

Atmosphere tested for flammable vapors (% LEL) Test Results (%)

Requestor

Work by contractor?

Name of Hot Work Operator

Fire Watch duration after work completed. (Standard is 30 minutes. )

Name of Hot Work Supervisor

Name of Fire Watch

Time

Room

Location

Name of PAI PAI Signature

I verify the stated location has been examined and precautions checked on the checklist. The requested hot work is:

Approved Approved, pending resolution of the following items:

Checklist Items Other Precautions / Notes

+ Inform requestor of Approval or Pending Approval with list of deficiencies to correct prior to work.

+ Notify Building Security Control, Building Manager, Building Safety Coordinator, Fire Shop & Utility Control of hot work.

Email Phone

To be completed by Requestor:

To be completed by Permit Authorizing Individual within 24-hrs of work:

Time

(Permit is valid for a maximum of 24 hours.)

Permit Expires: Date

Instructions:

l Requestor completes Box 1 and submits to PAI.

l PAI completes Boxes 2 & 3.

l PAI initials Box 4 on Part B to indicate site work approval. PAI retains Part A for records. (MMDDYY) (Facility) (ABC/#)

Date

Name, Unit/Company1

Required: ≤ 10% LEL

Flammable liquids, compressed gas cylinders, dust, lint, and oily deposits moved/removed.

Explosive atmospheres in area eliminated (e.g. use of solvents halted).

Combustibles on other side of wall shielded/moved away.

Combustible floors (wood, tile, carpeting) wet down, covered with damp sand or fire blankets Combustible materials moved where possible.

Otherwise, protected with fire blankets, guards, or fire resistive shields.

Hot work equipment in good condition (e.g. power source, welding leads, torches, etc.)

Adequate ventilation available to remove smoke/ vapor from work area to a safe location.

Containers/vessels purged of flammable liquids and vapors.

Equipment Locked-Out/Tagged-Out where required.

Less common items:

Ye s

N /A

Ye s

N /A

REQUIREMENTS WITHIN OF WORKYe s

N /A

ENCLOSED EQUIPMENT, CONTAINERS, OR VESSELS

WORK NEAR WALLS/CEILINGS

Today's Date

Additional Fire Watch required.

PAI (initial to confirm that needed corrective actions were taken, otherwise leave blank)

Last View

HOT WORK PERMIT - PART B

Requestor Work by contractor?

Facility Building

Room

Location

Hot Work Type Emergency Request (< 48hrs notice).

Description of Work

Name of Hot Work Supervisor

Name of Hot Work Operator

Name of Fire Watch

Permit Expires: DatePermit Start: Date Time Time

Test Results (%)

To be completed by Hot Work Supervisor within 1-hour of work:

Hot Work Supervisor Signature

I verify the stated location has been examined and precautions checked on the checklist. All deficiencies and instructions identified by the PAI have been resolved and followed, respectively.

General Information:

To be completed by Fire Watch before work begins:

Fire Watch Signature

I verify that I performed fire watch duties and was on site for

Fire watch trained in sounding fire alarm.

Fire extinguisher is provided at work site.

Fire watch trained in use of fire extinguishers.

To be completed by PAI or COTR (for contractor work) upon completion of work:

Signature I verify that the above work is complete and the work site was inspected for signs of fire damage.

Return Part B to be filed with Part A in records.

PAI

COTR

Name

Comments or Issues

(MMDDYY) (Facility) (ABC/#)

Date

Date

Date

Instructions:

l Hot work supervisor completes Box 5 and posts Part B in vicinity of hot work (PAI must initial Box 4).

l Fire watch completes Box 6 before and after work, as appropriate.

l PAI/COTR finalizes in Box 7. Part B returned to PAI for records.

SI Tracking Number

(Permit is valid for a maximum of 24 hours.)

Additional fire watch on site (if required).

Sprinklers and hose stations in service/operable.

Portable fire extinguisher available.

Construction is noncombustible or protected.

No risk of heat conduction into another room/area, or second fire watch required for that space.

Ye s

N

/A GENERAL PRECAUTIONS

Nearest phone identified.

Nearest fire alarm pull station identified.

14 Combustibles on other side of wall shielded/moved away.

Hot work equipment in good condition (e.g. power source, welding leads, torches, etc.)

Adequate ventilation available to remove smoke/ vapor from work area to a safe location.

Less common items:

Ye s

N

/A WORK NEAR WALLS/CEILINGS

All wall and floor openings covered.

Walkways below hot work area protected.

Enclosed equipment cleared of all combustibles.

Atmosphere tested for flammable vapors (% LEL)

Required: ≤ 10% LEL

Flammable liquids, compressed gas cylinders, dust, lint, and oily deposits moved/removed.

Explosive atmospheres in area eliminated (e.g. use of solvents halted).

Combustible floors (wood, tile, carpeting) wet down, covered with damp sand or fire blankets Combustible materials moved where possible.

Otherwise, protected with fire blankets, guards, or fire resistive shields.

Containers/vessels purged of flammable liquids and vapors.

Equipment Locked-Out/Tagged-Out where required.

Ye s

N /A

REQUIREMENTS WITHIN OF WORKYe s

N /A

ENCLOSED EQUIPMENT, CONTAINERS, OR VESSELS

Time

PAI Approval4 after the end of hot work activities.

Last View

Be fo re

A ft er

HOT WORK PERMIT FORM

GENERAL INSTRUCTIONS

Summary:

The Hot Work Permit Form is to be used for conducting hot work outside of designated (fixed) hot work areas, meeting all applicable fire protection regulations. The supervisor is responsible for the hot work being performed. He / she is responsible for requesting a permit prior to work. He / she will ensure that all staff working in the area are trained and have read SI Safety Manual, Chapter 14 – Hot Work Management and Permit System. The Hot Work Supervisor will ensure that the area is inspected prior to work and that a Fire Watch is present during work and remains for at least 30 minutes after hot work is completed. The Permit Authorizing Individual (PAI) shall inspect the hot work area prior to granting a permit. The PAI will verify and sign off on the permit, with additional instruction to the Hot Work Supervisor if necessary. The permit is void unless copies of the permit are posted in the area and provided to Security Control Room Operator, Building Management and Safety Coordinator.

Part A is intended to remain with the PAI and be distributed to Security Control Room Operator, Building Management and Safety Coordinator. Part B is intended to be posted at the hot work site. The Hot Work Area Supervisor or Contracting Office Technical Representative (COTR) must return the completed Part B of the permit to the PAI on the next work day. The PAI will file both permit parts with the building records.

This form is a fill-able PDF document that can be saved with the form fields filled-in. It has been tested to work properly with Adobe Reader 10 and Adobe Reader 11. Earlier versions of Adobe Reader may not work properly.

Instructions:

1) The person/company requesting permission to conduct hot work fills out Box 1 on Part A. Most fields are self explanatory.

* Filling in the fields in Box 1 will automatically fill the same boxes on Part B of the permit.

* The "Facility" field should use acronyms where possible (e.g. "NMAH" instead of "American History").

* The "hot work type" drop-down has five basic hot work types that can be selected. If the work is not one of these types, it may be typed manually. The type of hot work will dictate the required inspection distance in the site checklist as follows:

Welding 35ft Brazing 15ft Grinding 35ft Soldering 10ft Cutting 35ft {Other} 35ft

* If the requested permit start date and time is less than 48 hours from the present time, the Emergency Request check box will automatically be marked.

* The permit expiration date and time will be automatically calculated and filled in based on a 24-hour limit (can be manually edited to less than 24-hours if desired).

* The Requestor should save the filled-in permit PDF and email it to the PAI.

* The PAI should bring a hardcopy of Parts A & B to the site inspection.

2) The PAI should assign a tracking number for easier record keeping. The "MMDDYY" and "Facility" parts of the tracking number will be automatically assigned from the Requestor input. Only a number and/or letter sequence needs to be added.

3) The PAI must inspect the work site within 24-hours of the work, using the checklists in Box 3. Where the work is scheduled for Monday morning or after a holiday, the site may be inspected on the prior workday, if no work will occur at the site over the weekend or holiday. The PAI and Hot Work Supervisor may inspect the site together if it is within 1-hour of the work.

Items 1 to 12 will always be inspected. Items 13 to 19 are less common, and may or may not be appropriate. Any items that are not applicable must be checked "N/A".

4) The PAI must approve or conditionally approve the hot work request and communicate the disposition to the Requestor. Where conditional approval is granted, the PAI must specifically inform the Requestor of actions required prior to the start of work. The PAI must confirm completion of required corrective actions and sign Part A (Box 3) and initial Part B (Box 4) before work begins.

5) The PAI must notify Building Security Control, Building Manager, and Building Safety Coordinator of approved hot work.

6) The Hot Work Supervisor must inspect the site within 1 hour of work using the checklist in Box 5 on Part B. The Hot Work Supervisor must follow all other instructions received from the PAI.

7) The Fire Watch must be on-site with a fire extinguisher prior to the start of work, and complet the appropriate parts of Box 6.

Once work is complete, the Fire Watch must monitor the site for the required duration, then finish Box 6 on Part B.

8) The PAI or COTR must complete Box 6 on Part B, verifying that the work was complete and inspecting the work site for signs of fire damage. Any comments about or issues encountered during the hot work should be noted in Box 7. Part B must be returned and filed with Part A in the records. At the discretion of the PAI, an electronically scanned copy of the completed Part B may be returned for record.

HOT WORK PERMIT - PART A

SI Tracking Number (by PAI) Yes N/A

GENERAL PRECAUTIONS

(Standard is 30 minutes. ) I verify the stated location has been examined and precautions checked on the checklist. The requested hot work is:

+ Inform requestor of Approval or Pending Approval with list of deficiencies to correct prior to work.

+ Notify Building Security Control, Building Manager, Building Safety Coordinator, Fire Shop & Utility Control of hot work.

H:\forms\999999f3xccl2.gif To be completed by Requestor:

To be completed by Permit Authorizing Individual within 24-hrs of work:

(Permit is valid for a maximum of 24 hours.)

Instructions:l Requestor completes Box 1 and submits to PAI.l PAI completes Boxes 2 & 3.

l PAI initials Box 4 on Part B to indicate site work approval. PAI retains Part A for records.

(MMDDYY) (Facility) (ABC/#) Date Name, Unit/Company Required: ≤ 10% LEL Less common items:

Yes N/A Yes N/A

REQUIREMENTS WITHIN

OF WORK

Yes N/A

ENCLOSED EQUIPMENT, CONTAINERS, OR VESSELS

WORK NEAR WALLS/CEILINGS

(initial to confirm that needed corrective actions were taken, otherwise leave blank)

HOT WORK PERMIT - PART B

H:\forms\999999f3xccl2.gif To be completed by Hot Work Supervisor within 1-hour of work:

I verify the stated location has been examined and precautions checked on the checklist. All deficiencies and instructions identified by the PAI have been resolved and followed, respectively.

General Information:

To be completed by Fire Watch before work begins:

I verify that I performed fire watch duties and was on site for To be completed by PAI or COTR (for contractor work) upon completion of work:

I verify that the above work is complete and the work site was inspected for signs of fire damage.

Return Part B to be filed with Part A in records.

(MMDDYY) (Facility) (ABC/#) Date Date Date Instructions:

l Hot work supervisor completes Box 5 and posts Part B in vicinity of hot work (PAI must initial Box 4).

l Fire watch completes Box 6 before and after work, as appropriate.

l PAI/COTR finalizes in Box 7. Part B returned to PAI for records.

SI Tracking Number (Permit is valid for a maximum of 24 hours.)

Yes N/A

GENERAL PRECAUTIONS

Less common items:

Yes N/A

WORK NEAR WALLS/CEILINGS

Required: ≤ 10% LEL Yes N/A

REQUIREMENTS WITHIN

OF WORK

Yes N/A

ENCLOSED EQUIPMENT, CONTAINERS, OR VESSELS

Time after the end of hot work activities.

Before After

HOT WORK PERMIT FORM

GENERAL INSTRUCTIONS

Summary:

The Hot Work Permit Form is to be used for conducting hot work outside of designated (fixed) hot work areas, meeting all applicable fire protection regulations. The supervisor is responsible for the hot work being performed. He / she is responsible for requesting a permit prior to work. He / she will ensure that all staff working in the area are trained and have read SI Safety Manual, Chapter 14 – Hot Work Management and Permit System. The Hot Work Supervisor will ensure that the area is inspected prior to work and that a Fire Watch is present during work and remains for at least 30 minutes after hot work is completed. The Permit Authorizing Individual (PAI) shall inspect the hot work area prior to granting a permit. The PAI will verify and sign off on the permit, with additional instruction to the Hot Work Supervisor if necessary. The permit is void unless copies of the permit are posted in the area and provided to Security Control Room Operator, Building Management and Safety Coordinator.

Part A is intended to remain with the PAI and be distributed to Security Control Room Operator, Building Management and Safety Coordinator. Part B is intended to be posted at the hot work site. The Hot Work Area Supervisor or Contracting Office Technical Representative (COTR) must return the completed Part B of the permit to the PAI on the next work day. The PAI will file both permit parts with the building records.

This form is a fill-able PDF document that can be saved with the form fields filled-in. It has been tested to work properly with Adobe Reader 10 and Adobe Reader 11. Earlier versions of Adobe Reader may not work properly.

Instructions:

1) The person/company requesting permission to conduct hot work fills out Box 1 on Part A. Most fields are self explanatory.

* Filling in the fields in Box 1 will automatically fill the same boxes on Part B of the permit.

* The "Facility" field should use acronyms where possible (e.g. "NMAH" instead of "American History").

* The "hot work type" drop-down has five basic hot work types that can be selected. If the work is not one of these types, it may be typed manually. The type of hot work will dictate the required inspection distance in the site checklist as follows:

Welding 35ft Brazing 15ft Grinding 35ft Soldering 10ft Cutting 35ft {Other} 35ft

* If the requested permit start date and time is less than 48 hours from the present time, the Emergency Request check box will automatically be marked.

* The permit expiration date and time will be automatically calculated and filled in based on a 24-hour limit (can be manually edited to less than 24-hours if desired).

* The Requestor should save the filled-in permit PDF and email it to the PAI.

* The PAI should bring a hardcopy of Parts A & B to the site inspection.

2) The PAI should assign a tracking number for easier record keeping. The "MMDDYY" and "Facility" parts of the tracking number will be automatically assigned from the Requestor input. Only a number and/or letter sequence needs to be added.

3) The PAI must inspect the work site within 24-hours of the work, using the checklists in Box 3. Where the work is scheduled for Monday morning or after a holiday, the site may be inspected on the prior workday, if no work will occur at the site over the weekend or holiday. The PAI and Hot Work Supervisor may inspect the site together if it is within 1-hour of the work.

Items 1 to 12 will always be inspected. Items 13 to 19 are less common, and may or may not be appropriate. Any items that are not applicable must be checked "N/A".

4) The PAI must approve or conditionally approve the hot work request and communicate the disposition to the Requestor. Where conditional approval is granted, the PAI must specifically inform the Requestor of actions required prior to the start of work. The PAI must confirm completion of required corrective actions and sign Part A (Box 3) and initial Part B (Box 4) before work begins.

5) The PAI must notify Building Security Control, Building Manager, and Building Safety Coordinator of approved hot work.

6) The Hot Work Supervisor must inspect the site within 1 hour of work using the checklist in Box 5 on Part B. The Hot Work Supervisor must follow all other instructions received from the PAI.

7) The Fire Watch must be on-site with a fire extinguisher prior to the start of work, and complet the appropriate parts of Box 6.

Once work is complete, the Fire Watch must monitor the site for the required duration, then finish Box 6 on Part B.

8) The PAI or COTR must complete Box 6 on Part B, verifying that the work was complete and inspecting the work site for signs of fire damage. Any comments about or issues encountered during the hot work should be noted in Box 7. Part B must be returned and filed with Part A in the records. At the discretion of the PAI, an electronically scanned copy of the completed Part B may be returned for record.

8.2.1.4029.1.523496.503679