Hot Work Permit Request

A. Proposal

To be completed by the person responsible for carrying out the work

Building(Required)

Specific area of hotwork (e.g. Room 1501)(Required)

Nature of hot work to be undertaken(Required)

Other: Nature of hot work to be undertaken

Please describe.

The above location has been examined and the precautions listed on this form below have been complied with as indicated.

Requestor Name(Required)

Requestor Phone Number(Required)

Requestor Email(Required)

The Responsible Person Is(Required)

B. Agreement

Start Date(Required)

End Date(Required)

C. Fire Watch

D. Procedure for Hot Work permits

This hot work permit is required for any temporary operation involving open flames or sparks. This involves but is not limited to: brazing, cutting, grinding, soldering, thawing pipes, torch-applied roofing, and welding.
1.	NC State Fire and Life is approving this permit and the requester and responsible parties agree to the safety requirements and expectations as listed below.	5.	Upon completion of this permit application, a checklist regarding fire protection measures, safety requirements and safe use of equipment is required to be completed.
2.	A permit is required prior to starting work. This should be done on every occasion that hot work of any type is undertaken within or on the fabric of established buildings or any structures in the open. This procedure also applies to construction sites.	6.	If Fire and Life Safety is not satisfied with the arrangements, further measures may be requested. A pre-check inspection is required by the responsible party listed in the permit application. If trained personnel will not be available to make this check (for example in the case of a permit issued late in the day) work must be rescheduled. A fire watch is required for at least 30 minutes after the work is complete.
3.	A Hot work permit should not be issued without considering the significance of any other permits to work in the vicinity, or adjacent manufacturing processes which may involve the use of flammable liquids or gasses.	7.	The hot work permit should be printed and accessible on site for those who may wish to inspect the site of work or perform spot checks, to ensure that conditions have been met and that work is complete before the hot work permit expires.
4.	A Hot work permit should also be issued for a specific task that is undertaken in a clearly identified area. Hot work permits should not be issued for more than a 24 hour period.

E. Hot work permit checklist

Precautions within 35 feet (minimum) of the work

Equipment

F. Compliance

I agree to the above safety expectations and requirements of hot work. Failure to comply with the outlined safety expectations and work requirements will result in the revocation of the hot work permit.(Required)

Please type your initials.

A. Proposal

B. Agreement

C. Fire Watch

D. Procedure for Hot Work permits

E. Hot work permit checklist

F. Compliance

Fire and Life Safety

EMERGENCY – Dial 911

Directions To FLS

ASK A QUESTIONor call 919-515-2568.