UMBC - Hot Work Permit

Building: ________________________ Room/Area:________________ Date: ____/____/___

Department/Contractor: __________________________________________________________

Cutter/Welder: _____________________________ Fire Watcher: _____________________________

Start Date: ___/___/___ End Date: ___/___/___ Time Range: _____ a.m./p.m. to _____a.m./ p.m.

Circle or check all applicable issues below

HOT WORK TYPE WORK AREA/EQUIPMENT CONTAINER / PIPE CONTENTS

(past or present material)

Brazing Welding Exterior Interior

Cutting Arc ___ Building Structure _______________________________________

Air Arc MIG ___ Building Fixture

Mechanical Oxy-Fuel ___ HVAC Unit Cleaned Y N

Oxy-Fuel TIG ___ Fume Hood Purged Y N

Plasma ___ Pipe How Cleaned/Purged: _____________________

Heating ___ Tank

Soldering ___ Valve Date Cleaned/Purged: ____/____/_____

_____________________ EH&S requested Y N

(other)

FIRE HAZARDS HEALTH & SAFETY ISSUES CYLINDER, EQUIPMENT & HOSE

Combustibles Asbestos Present Y N Gases Used

___ Covered Chemicals/Cleaners Present Y N ___ Butane

___ Removed Name: ____________________ ___ Oxy-Acetylene

___ None Present Confined Space Y N ___ Propane

Flammables Monitor required Y N Other: ________________________

___ Covered Permit required Y N

___ Removed Electrical Hazards Y N Cylinder Storage and Use

___ None Present GFCI required Y N Away from ignition source Y N

Floor / Wall Openings __________________Y N Cap or regulator in place Y N

___ Covered Heat Stress Precautions Y N Free of damage and leaks Y N

___ Not Applicable Water/Cups required Y N Labeled properly Y N

Work/Rest ratio ____/____ Outside of building/space Y N

DETECTION / PPE Required Y N Secured w/ chain or strap Y N

SUPPRESSION Clothing Eye Protect. Upright storage / transport Y N

Face Protect. Foot Protect.

Detectors Sprinklers Hand Protect. Head Protect. Hose, Leads and Torch

Beam Operational Respiratory Connections tight Y N

Heat Non-Oper. Neg. Pres. Pos. Pres. Flash arrestor in place Y N

Smoke Not Present Other: _________________ Free of damage and leaks Y N

Not Present Shields or Curtains Required Y N

-Bagged Additional Comments: ___________________

-Disconnected Ventilation Required Y N _______________________________________

Extinguisher Fire Watch ___ Negative Pressure _______________________________________

CO2 DryCh Y ½ hr ___ Positive Pressure _______________________________________

Hose P/W N 1 hr _______________________________________

N/A __ hr

______________________________ _______________________________

(Person performing Hot Work) (UMBC Representative)