Hot Work Permit Form
Please fill out this form to obtain a hot work permit for the specified job.
Applicant's Information
Full Name
First Name
Last Name
Job Title
Department
Supervisor's Name
Date of Work
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Work
Location of Work
Description of Work
Hot Work Equipment to be Used
Safety Precautions
Check all that apply
Are fire extinguishers available and in working condition?
Yes
No
Is a fire watch required?
Yes
No
Are welding screens or blankets available?
Yes
No
Has the area been inspected for flammable materials?
Yes
No
Safety Measures
Acknowledgment
By submitting this form, I acknowledge that I have reviewed the safety precautions and will adhere to the requirements for hot work.
Signature
Submit
Should be Empty: