Permit Request • CampusOptics

EVALUATE IF THE HOT WORK CAN BE AVOIDED OR COMPLETED IN A SAFER WAY.
FOLLOW CHECKLIST AND PRECAUTIONS LISTED TO THE RIGHT.
COMPLETE PERMIT AND DISPLAY IN AREA WHERE WORK IS BEING DONE.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Name* Required

Additional Location Details

Hot Work Applicant Information

Responsible Party* Required

Company/Department* Required

Project #* Required

Work Order #* Required

Job Description* Required

CHECKLIST & PRECAUTIONS

AVAILABLE FIRE SPRINKLERS, HOSE STREAMS, & EXTINGUISHERS IN SERVICE & OPERABLE.* Required

HOT WORK EQUIPMENT IS IN GOOD REPAIR.* Required

REQUIREMENTS WITHIN 35 FT OF WORK

COMBUSTIBLE FLOORS WET DOWN, COVERED WITH DAMP SAND, OR OTHER SHIELDING MATERIAL.* Required

FLOORS SWEPT CLEAN OF COMBUSTIBLES.* Required

EXPLOSIVE ATMOSPHERE IN AREA ELIMINATED.* Required

FLAMMABLE LIQUIDS, DUST, LINT, & OILY DEPOSITS REMOVED.* Required

ALL WALL AND FLOOR OPENINGS WITHIN 35 FEET COVERED.* Required

FIRE-RESISTANT COVERS SUSPENDED BENEATH WORK.* Required

OTHER COMBUSTIBLE MATERIALS REMOVED OR COVERED WITH FIRE-RESISTANT COVERS.* Required

HOT WORK CONDUCTED OUTSIDE

COMBUSTIBLE VEGETATION, MULCH OR OTHER MATERIAL IS WET DOWN OR PROPERLY COVERED* Required

AN ADEQUATE WATER SOURCE FOR EXTINGUISHMENT WILL BE PROVIDED* Required

HOT WORK WILL NOT BE DONE ON EXTREME WIND WARNING OR HIGH FIRE DANGER DAYS* Required

WORK ON WALLS AND CEILINGS

COMBUSTIBLES ON THE OTHER SIDE OF WALL MOVED AWAY.* Required

CONSTRUCTION IS NONCOMBUSTIBLE & WITHOUT COMBUSTIBLE COVERINGS.* Required

WORK ON/IN CONFINED SPACES

CONFINED SPACE CLEANED OF ALL COMBUSTIBLES.* Required

CONTAINERS PURGED OF ALL FLAMMABLE LIQUIDS & VAPORS.* Required

UNIVERSITY & COMPANY CONFINED SPACE GUIDELINES FOLLOWED.* Required

FIRE WATCH AND WORK AREA MONITORING

FIRE WATCH SHOULD BE PROVIDED DURING & FOR 30 MINUTES AFTER WORK IS COMPLETED.* Required

FIRE WATCH PERSONNEL EQUIPPED & TRAINED ON THE USE OF FIRE EXTINGUISHERS & ARE FAMILIAR WITH BUILDING FIRE ALARM SYSTEMS.* Required

FIRE WATCH MAY BE REQUIRED ABOVE, BELOW AND IN ADJACENT AREAS.* Required

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