Controlled Welding, Cutting, Grinding, and Open Flame Permit

Sample Hot Work Permit

Exhibit 2.9

Building No.

Location (Room, Basement, Roof, etc.)

CONTROLLED WELDING, CUTTING, GRINDING,

AND OPEN FLAME PERMIT

Description of Job and Object on which Hot Work is to be Performed

Period of Permit Authorization (Date and Time)

12 Hour Extention Review (Date, Time, Initials)

1. ___________________ 2. ___________________ 3. ___________________

4. ___________________ 5. ___________________ 6. ___________________

From:

To:

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 box located

Test for combustible gases required

Wall and floor openings protected or covered

Fire extinguisher required

Type____________________________________________

Supplemental ventilation required

Type____________________________________________

Respiratory protection required

Type____________________________________________

Job preparation complies with 29 CFR 1910.252(d).

The job location has been reviewed and complies with requirements above.

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 described above. The right to rescind this permit is reserved by the undersigned in case of unforeseen conflicts.

Signature

Building Manager

Date

This job has been completed as indicated below:

Upon completion of the job, sign below and return permit to Building Manager.

Yes

Work area has been cleaned up

Signature

Subsequent 1/2 hour fire watch completed

Supervisor of personnel doing work

Date