Sample Hot Work Permit

DOE-HDBK-1101-2004

Exhibit 2.9

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

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

Signature _____________________________

_______________

Work area has been cleaned up

Supervisor of personnel doing work

Date

Subsequent hour fire watch completed