Hot Work Permit Request Hot Work Permit Form Please tell us who will do the work: Note: Hot Work Permits must be submitted 72 hours in advance of work to be done. Name of Responsible Person:* First Last Email* Phone*Performing Shop or Company:* Structural Trades HVAC Plumbing Electric Shop Other Mines Department (enter department and supervisor name below) Contractor (enter company name, supervisor's name, and Mines project manager's name below) Department, Supervisor or Contractor Information: Tell us about the work itself: Work Start Date* MM slash DD slash YYYY Work Start Time* : Hours Minutes AM PM AM/PM Work End Date*(not to exceed a week from start date) MM slash DD slash YYYY Work End Time* : Hours Minutes AM PM AM/PM Building or Other Location:* Room, Area, or Equipment:* Check type of work and describe the work to be performed:* Welding Soldering Grinding Torch Work Other Work to be performed. Add pertinent details such as material type, utility system, approximate lengths/quantities of installed materials, etc.:* Verify all of the following: Check all boxes Required* Hot work equipment will be inspected and determined to be in good repair prior to the start of work. Required* This work cannot reasonably be done in a shop or other area designated for this purpose and equipped to minimize hazards. Required* No sprinklers will be taken out of service while this work is being done. If sprinklers have to be taken out of service while this work is being done, contact EHS for an alternate permit process at 303-273-3316. Required* The potential for smoke, heat, airborne dust, et cetera, to trigger a fire alarm has been evaluated and appropriate measures will be taken to prevent false alarms (including local horns and strobes and the automatic Fire Department notification). Advance arrangements may be necessary for a qualified Mines employee to deactivate and restore systems or components. Ensure that systems are restored as soon as possible after the completion of work so that fire watches can be minimized. If fire-detection system is taken offline then describe the actions to be taken and/or name of Mines employee performing work:If performing hot work within 20 feet of a smoke detector, detector head(s) must be protected from dust and smoke intrusion. Protection requires covering the head with plastic. DO NOT apply tape directly to detector.*Please indicate if your work will require detector heads to be covered. PROTECTION MUST BE REMOVED AT THE END OF EACH WORK DAY. Yes No Required* There are no combustible fibers, dusts, vapors, gases, or liquids in the area. There are no tanks or equipment that previously contained flammable liquids in this area. If the equipment needs to be purged and the absence of explosive gases or vapors verified with a combustible gas-detection instrument OR if there is a possibility of a leak developing in nearby piping, equipment, or tanks containing flammable liquids or gases, then contact EHS for an alternate permit process at 303-273-3316. Required* All combustibles will be relocated or protected from sparks within 35 feet of the work area. Protection may include containment of sparks, flame-proofed curtains, non-combustible coverings, or wetting agents. Required* Surrounding floors will be swept clean of paper clippings, wood shavings or textile fibers. Required* At minimum, a 5 lb. ABC rated extinguisher must be present in addition to the normal compliment of building extinguishers. Trained personnel to use them must be available at the job site. For Mines personnel, contact EHS if a fire extinguisher is needed. Required* All floor and wall openings, including cracks, within 35 feet of the operations will be protected from spark intrusion. Required* No hot work can be performed in windy conditions (15 mph sustained or gusts). Required* The need for a fire watch during work, work breaks, and for 60 minutes after completion has been evaluated and an appropriate number of responsible personnel will be assigned to this duty. Fire watch personnel must be in the immediate area of where the hot work was performed. (Based on the evaluation of the Hot Work Permit, EHS may require additional fire watch criteria.) Required* There will be no harmful radiation generated by this work, or protective measures will be taken. Protective measures may include fire-resistant screens or posting signage and restricting access to the work area. Required* Workers will not be exposed to toxic fumes and the work will not create an indoor air quality issue or else adequate ventilation controls will be implemented to prevent these problems. Required* Prior to starting work, workers will determine the location of the nearest: alarm pull station, building fire extinguisher, and telephone (accessible), and verify a clear escape route from the work area. Required* The person performing the hot work will verify the conditions specified in this permit prior to starting work each day that the permit is in effect. In addition, they will document that verification or re-verification for each day after the start date by adding their initials, with the date, to the permit kept at the work site (directly below the signature line). Note: If the work needs to be continued beyond the completion date specified on the permit, then a new permit application should be submitted. (It is not acceptable to keep initialing an expired permit.) If you are unable to meet any of the requirements above, contact EHS at 303-273-3316 to start the specialized hot work permit process. I attest that the above precautions are sufficient to prevent fire and unintended fire alarms, as well as to assure the health and safety of workers, bystanders, and building occupants. I understand that my company may be responsible for any fines incurred due to false alarms.Name* First Last Enter your name. This verifies that you have personally surveyed the work area and will stop work if the above conditions are not met.PLEASE PRINT THIS FORM PRIOR TO SUBMISSION for your records. You will also receive a copy of your submission via email. Please print and post this email at the work site. Scroll down, and press "Submit" to notify EHS and Facilities Management. If you have any questions, call EHS at 303-273-3316.
