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: Area Authority

SECTION 2: 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 3: Description of Location and Activity

SECTION 4: Permit Dates

SECTION 5: Permit Conditions
Permit Applicant to tick yes, no or NA to the following:

SECTION 6: Applicant Statement of Acknowledgement

I acknowledge the requirements of the Kimberley Ports Authority to identify and control risks and work in a safe manner at all times. I confirm the company I represent undertaking the work has satisfactory documented safe systems of work in place and that all permits and licences required are current. Once the permit is authorised ensure that section 9 is completed prior to commencement of activity.

Use your mouse or finger to draw your signature above.

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