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.

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.


DESCRIPTION OF LOCATION AND ACTIVITY


PERMIT DATES

Permit requested for
(to be filled out by permit applicant)

:
:

PERMIT CONDITIONS

Permit Applicant to tick yes or no to the following

Will a pre-start discussion take place?*
Has a JHA been prepared that identifies PPE, Barricading/signage, ventilation/wind direction, cool down of area at completion and inspection to be carried out after 30 mins?*
Has the area where hot work will be occurring been assessed for potential hazards and cleared of any combustible materials that may catch fire during the hot work operations?*
Will all Machinery / Equipment be isolated and Tagged Out as necessary?*
Has the person(s) operating the Hot Work equipment been deemed competent?*
Has a fire watch person been selected to supervise the area during the activity? *
Will the following equipment be on standby at all times; fire extinguisher, fire blanket, water supply (buckets of water or water hose) and communication (mobile or radio)*
Is the area in which hot work is to be conducted in close proximity to flammable liquid, explosive or hazchem storage facilities? If yes, special precautions may apply, Permit Authoriser is to refer to the Harbourmaster or Engineer or their delegate.*
Is the Hot Work to be conducted in a confined space?*
For KPA contractors or employees - confirm the above actions have been reviewed and a Work Pack will be completed by the Maintenance Leading Hand or their delegate.*

APPLICANT STATEMENT OF ACKNOWLEDGEMENT

By signing this document, the Applicant:

  • Agrees that they are responsible for the works being undertaken and that they and their contractors will work in a safe manner at all times;
  • 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.
 
*There are errors on the form. Please check entered values.