UMBC - Environmental Safety and Health

Hot Works Permit

University of Maryland Baltimore County

Before any job, task or operation associated with the following (producing heat, sparks, open flames and or smoke), this hot work permit is required to be filled out and signed by the operation supervisor who will be competent with regard to Hot Work. This permit must be posted at the operation site. If for any reason, the permit can not be fully completed or the precautions listed under this permit can not be met, hot work is prohibited.
Questions or comments regarding this permit can be directed to UMBC Environmental Safety and Health (410) 455-2918. IN CASE OF FIRE, DIAL 911

Employee Information

First Name*

Last Name*

Email*

Phone*

Fax

Operations Supervisor First Name*

Operations Supervisor Last Name*

Request Information

Company/Contractor Name*

Type

Work Order No

Building where work will occur

Floor or Room where work will occur*

Nature of Work*

Hot Work Operator Name(s)*

Permit Date

Permit Request Effective Date*

Permit Request Expiration Date*

You must agree to adhere to the following precautions by checking each item.


	I agree
Appropriate arrangements have been made with UMBC Work Control Center to prevent the accidental activation of fire detection and alarm systems.
A responsible fire watcher has been assigned to watch for dangerous sparks in area, as well as floors above and below and will remain on the job site for 30 minutes after completion of hot work.
All equipment to be used has been inspected and is in good repair.
Appropriate fire extinguishing equipment is within 10 ft. of work site. (company/contractor provides their own fire extinguishing equipment)
Floor openings within 35 feet are tightly covered.
Floors and surrounding area are clear of combustible materials within 35 feet of the work area.
Materials that cannot be moved are protected with noncombustible material or cover.
The sprinkler system, where provided, is in service.
There are no flammable liquids, vapors, dusts, lints OR equipment containing such materials in the work area.

I verify the information on this hot work permit is correct and, furthermore, that the above location has been examined for the precautions listed on this permit to prevent fire. Appropriate fire extinguishing equipment is available within 10 ft. of work site