Hot Work Permit Request

Hot Work Permit Form

  • Please tell us who will do the work:

  • Tell us about the work itself:

  • :
  • (not to exceed a week from start date)
  • :

  • Verify all of the following:

    Check all boxes

  • Please indicate if your work will require detector heads to be covered. PROTECTION MUST BE REMOVED AT THE END OF EACH WORK DAY.

  • 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.

  • 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, complete the "CAPTCHA", and press "Submit" to notify EHS and Facilities Management. If you have any questions, call EHS at 303-273-3316.