UC San Diego Environment, Health and Safety Hot Work Permit - Fire & Life Safety Division - Chuck Strickland, Fire Marshal 9500 Gilman Drive ◦ La Jolla, CA 92093-0920 Phone: (858) 822-5706 ◦ Cell: (858) 967-5800 ◦ cestrickland@ucsd.edu ARCHIVE DOCUMENT - THIS DOCUMENT WILL BE KEPT ON FILE BY THE FIRE MARSHAL - PLEASE DO NOT DISCARD! Please allow 72 hours to process this request. This hot work permit is required for all temporary operations involving open flames, or producing heat and/or sparks. Permit must be posted in the work area with appropriate signage. Hot Work includes but is not limited to: Brazing, cutting grinding, soldering, torch applied roofing, welding. GENERAL INFORMATION CONTRACTOR PERFORMING WORK: MAXIMUM DURATION OF PERMIT IS ONE WEEK. LOCATION: PERMIT START DATE: NATURE OF WORK: EXPIRATION DATE: NAME OF PERSON(S) PERFORMING HOT WORK: FIRE PREVENTION AND PROTECTION CHECKLIST Complete the following checklist for all steps taken / needed to protect the work area. Fire Systems Work On Enclosed Equipment Or Spaces Available sprinklers, hose streams, and extinguishers are in service/operable. Enclosed equipment or space cleaned of all combustibles. Work does not create hazardous gas or potential for buildup (argon, welding, 2 Fire Extinguishers 2.5 gallon water & 5 lb ABC is within 10 feet of work. fumes, particulates etc.). Area Preparation Containers purged of flammable liquids / vapors. Flammable liquids, dust lint, and oil deposits removed/cleaned within a 35 foot radius of the hot work. Hot Work On Walls, Ceilings, or Upper Decks / Floors Construction material is non-combustible. Welding screens installed. Combustibles on other side of walls are moved away. Explosive atmosphere in area eliminated. Construction material is covered with non-combustible covering or insulation. No flammable chemicals or liquids within 35 feet of Hot Work. Floors are swept clean and combustible floors are wet down, covered with damp sand, fire protective tarp, or other protection. Remove all combustibles where possible. If not possible, ensure all combustibles are protected with fire-resistive sheets, tarps or metal shields. All areas and floors below have been examined for combustibles. Fire Watch / Hot Work Area Monitoring All wall and floor openings covered to prevent falling sparks. Fire watch will be provided during and for 30 minutes after work, including any coffee or lunch breaks. Fire resistant tarps suspended beneath work. Fire watch is supplied with suitable extinguishers, charged small hose and is trained in the use of this equipment. Smoke detectors in the area have been covered to prevent false alarm. Fire watch is in communication with hot works activities. Hot work equipment in good repair. Separate fire watch may be needed for other floors, behind walls, or other areas. Sprinkler heads that could be activated by the hot work have been covered with a wet rag. Fire monitor has no responsibilities other than fire watch. Other Precautions Taken: IN CASE OF FIRE: Activate the nearest fire alarm pull station and call from a cell phone 858 534 4357 CONTRACTOR SUPERVISOR SIGNATURE: By signing, you verify that the above location has been examined and that the above precautions have been taken. FIRE WATCH SIGN-OFF PRINT THE NAME OF THE PERSON DOING THE HOT WORK: Verify that the above hot work will be completed for the day, the work area and all adjacent areas to which sparks or heat may have spread were inspected and found to be safe. PRINT THE NAME OF THE FIRE WATCH MONITOR: Verify that the work area and all adjacent areas will be monitored for 1/2 hour following the Hot Work & declared to be safe. UC SAN DIEGO FIRE MARSHAL AUTHORIZATION UC SAN DIEGO FIRE MARSHAL SIGNATURE: