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Hot Working PermitPage 1 of 3

PART A1 - A6 Completed by Issuer

A2 - PERMIT VALID FROMPermits may only be issued up until 4pm eachday.Permits are only valid for one day. A newpermit is required each day.

Time Date TO Time Date

A3 - WORK DETAILSContractor name Person requesting permit

Exact location of Hot Work

Nature of Hot Work (i.e. Arc, gas welding, grinding)

Description of works

A4 - RISK ASSESSMENT

HAZARD IDENTIFIED RISK CONTROLS

A5 - ISOLATION OF FIRE ALARM *some notice may be required*Details of Authorised PersonPerson who will disable alarm

Detail here measures to isolate fire alarm system

A6 - PERMIT AUTHORISATIONBy authorising this permit - I confirm that the relevant Site Technical Officer / Site Manager / PremisesOfficer / Maintenance Manager has been notified of the works.

Signed Print Date

PART B1 - B5 - Completed by Contractor

1. One signed copy of this permit to be retained by the issuer.2. The contractor is to present his copy to the Premises Officer to obtain keys, etc.3. Upon completion of the works. The contractor is to return the completed form to the issuer.

Form design 10 Aug 2009L R Welling

A1 - Permit Number:

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Hot Working PermitPage 2 of 3

B2 - Hot Work Assessment - Prior to Works Commencement

Have fire doors with magnetic hold open devices, in the vicinity of the works, been closed?

Are floors and surrounds swept clean and clear of rubbish?

Has all combustible stock, plant, insulations etc been located 12m from the operation or the remainder protected from heat andsparks with non-combustible curtains, metal guards or flame-proofed covers (not ordinary tarpaulins)?

Has any floor or wall opening or open mesh flooring within 12m of the cutting and welding operations been covered over tightly?

Has a trained, responsible person with authority to stop the work and to regularly check the area, particularly during lunch breaksand rest periods, been appointed?

Has a trained, responsible person been assigned to watch for dangerous sparks in the area, as well as floors above and below inadjacent areas?

Has contractor fire fighting equipment (e.g. extinguishers, water/sand buckets, fire blankets) been provided, NOT ISS equipment?

Have all operatives undertaking the works been trained in the use of the fire fighting equipment?

Have warning notices been posted adjacent to, and where necessary, below the work area?

Are all gas cylinders safely secured in upright positions and gas pipes and cable in good condition properly secured and kept asshort as possible?

Do the operatives know where the nearest fire alarm break glass point is located?

Is the work permit clearly displayed at the job location?

Has the work area been designated a no smoking area?

Do all staff know the procedures for discovery of a fire and raising the alarm?

Is correct Personal Protective Equipment provided and worn in relation to the task?

If Tar boilers are used on roofs, has a non combustible heat insulating base been provided to prevent heat igniting the roof?

Are Tar boilers supervised by experienced persons and never left unattended unless switched off?

If operating adjacent to a gas supply, has the gas been turned off or the pipe protected?

Are gas cylinders positioned 3 metres away from the burner?

Have flash back arrestors been fitted to gas cyl inders?

Have welding, cutting or grinding operations been screened off using a non combustible material?

Are facilities available to summon assistance in the event of an emergency?

B3 - Record of Incidents

1. One signed copy of this permit to be retained by the issuer.2. The contractor is to present his copy to the Premises Officer to obtain keys, etc.3. Upon completion of the works. The contractor is to return the completed form to the issuer.

Form design 10 Aug 2009L R Welling

B1 - Receipt by Contractors Representative

The contents of the Hot Working Assessment have been fully explained to me and I understand therequirements and responsibilities placed upon me.

If any changes occur in the nature or scope of the work, or unforeseeable hazards are identified after thework has started, the Hot Work must cease immediately and the permit issuer contacted.

Signed Print Date

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Hot Working PermitPage 3 of 3

B4 - CompletionThe work area must be checked at 3 stages upon completion: - Immediate completion, after 30mins and after 1

hour.

IMMEDIATE CHECK

Is work area clean, tidy and safe?

Have checks been made for smouldering debris?

Have all detector head covers been removed?

Have all fire alarm zones been checked, confirmed as operational and the system been put online?

30 MIN CHECK

Work area checked at:- 30 minutes

1 HOUR CHECK

Work area checked at:- 1 hour

B5 - Completion sign off

To be signed by the competent person on completion of ALL tasksBy signing, I confirm thatnotification has been given to the permit issuer for re-activation of the firealarm system

Signed Print Time

Upon completion of this permit, it must be returned to the issuing authoriser.

A sketch of the area should be attached.

1. One signed copy of this permit to be retained by the issuer.2. The contractor is to present his copy to the Premises Officer to obtain keys, etc.3. Upon completion of the works. The contractor is to return the completed form to the issuer.

Form design 10 Aug 2009L R Welling