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Documentation Requirements - doe-hdbk-1101-20040093
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DOE-HDBK-1101-2004
Exhibit 2.9
Sample Hot Work Permit
Building No.
Location
CONTROLLED WELDING, CUTTING, GRINDING AND OPEN FLAME
(Room,
PERMIT
Basement, Roof,
Sample Hot Work Permit
etc.)
Exhibit 2.9
Description of Job and Object on which Hot Work is to be performed
Period of Permit Authorization (Date and Time)
12-Hour extension review (Date, Time, Initials)
From:
To:
1. ________
2. __________
3. _________ 4. ________ 5. _________ 6. ______
Yes
No
Special Instructions and Names of Persons Involved
__
__Radiation Work Permit required
__
__Fire Sprinkler System in service(where applicable)
__
__Curtain or fire blanket to catch sparks
__
__Combustibles removed or covered within 35 feet
__
__Painted surfaces protected
__
__Service piping and electrical systems protected
__
__Nearest Fire alarm located
__
__Test for combustible gases required
__
__Wall and Floor openings protected or covered
__
__ Fire Extinguisher required
Type ______________
__
__Supplemental ventilation required
Type ______________
__Respiratory protection required of Change
2.10 Management
__
Type ______________
29 CFR 1910.119 (l)
Job Preparation complies with 29 CFR 1910.252(d)
The job location has been reviewed and complies with requirements above.
Signature___________________________
___________
Signature______________________________
_________
Project Manager/Field Engineer
Date
Supervisor of personnel doing work
Date
Subject to strict adherence during the permit authorization period, protective requirements, other specified restrictions; permission is granted for welding, cutting,
grinding, and/or open flames within the location above. The right to rescind this permit is reserved by the undersigned in case of unforeseen circumstances.
Signature_________________________________
Date__________________
Building Manager
This job has been completed as indicated below:
Upon completion of the job, sign below and return permit to Building Manager.
Yes
No
Signature _____________________________
_______________
__
__
Work area has been cleaned up
Supervisor of personnel doing work
Date
__
__
Subsequent hour fire watch completed
78


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