Introduction to Fire Safety Management

Introduction to Fire Safety Management
168
 
NB a copy of the Method Statement and risk assessment for the works should be attached to this form
Results of atmospheric test:
NB. Attach certifi cate of test results of this PTW
form
Test no..........................Date......./......./....... 
Result..............% oxygen
The following precautions will be taken during the works:
1. 
A trained person not directly involved with the work will provide a continuous fi re watch during the 
period of hot work
2. 
At least two suitable extinguishers are immediately available. Personnel undertaking the work and 
providing the fi re watch are trained in their use
3. 
Emergency arrangements to stop work, make safe area and evacuate have been established (if 
alarm not set off by hot work processes)
Part C 
Acceptance
I have read and understood this permit and will ensure that all the precautions detailed in 
Part B above have been, or will be taken.
Signed...............................................Position......................................................Date...../...../.....at.....hrs
Part D 
Completion
I declare that the permitted hot work has been completed...........................on...../...../....at.....hrs
Signed................................................Position...................................................... 
Date...../...../.....at.....hrs
Part E 
Request for an extension
The work has not been completed and an extension is requested
Signed..........................................Position.................................................Date...../...../.....at.....hrs
Part F 
Extension
I have re-examined the area and confi rm that the permit may be extended to..../...../...../at.....hrs
Signed.................................................Position......................................................Date...../...../.....