Hot Work Permit

This form is for the purpose of obtaining permission to conduct Hot Work outside designated hot work areas, and to ensure that hazards associated with hot work activity are controlled.

SECTION 1: Applicant Details
Name of Permit Applicant
( person undertaking work onsite )
Company representative/contact filling out permit
( if different to permit applicant )
Note: The vessel will apply for a hot work permit if hot work is being undertaken by the ship’s crew and on the vessel. If a contractor is undertaking the hot work on the vessel then the contractor will apply for the hot work permit.
SECTION 2: Description of Location and Activity

SECTION 3: Permit Dates
TO

SECTION 4: Permit Conditions
Permit Applicant to tick yes, no or NA to the following:

SECTION 5: Applicant Statement of Acknowledgement

By signing this document, the Applicant:

  • Agrees that they are responsible for the works being undertaken and that they will work in a safe manner at all times and ensure that their contractors work in a safe manner;
  • Confirms that the company they represent and contractors they use at the Port of Broome will:
  1. have safe systems of work in place;
  2. use equipment that is certified (when required) and fit for purpose;
  3. be competent in the type of work being undertaken; and
  4. hold all required permits and licences.
Signature:
Use your mouse or finger to draw your signature above.

 
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