The University of Texas at Tyler
Date Work to Begin:
Date of Issue:
Date of Completion/Expiration:
Company Name:
Emergency Contact Number:
Phone Number:
Hours of Operation:
Location of Site Where Work is to be Performed: Inside Outside
Description of Work to be Performed:
Equipment to be Used:
Electric Arc
Acetylene Generator
Acetylene Torch
Calcium Carbide
Gas Cylinders
Other _______________________
Propane Torch
Fire Alarm & Detection System Impairment Required? Yes* No
*If YES then “Fire System Shutdown Form” must be completed
Cylinder Storage Required? Yes No
Location: Inside Outside
All hot work operations shall be performed in accordance with the requirements established by OSHA,
NFPA 51B Standards, UT System, and The University of Texas at Tyler Hot Work Program.
Compliance with all requirements established in the documents listed above shall be the responsibility of all
personnel performing hot work operations.
Emergency Phone Number: 903-566-7300 EH&S: 903-566-7011 Physical Plant: 903-566-7431
Inspection Date:
Inspection Time:
EH&S Director (or Designee) Signature:
On-site Foreman’s/Supervisor’s Signature:
COPIES: Maintain at Work Site / Send to EHS and Physical Plant
Fire Systems and Equipment
Available sprinklers, hose streams and extinguishers are in service/operable.
Hot Work equipment in good repair.
Requirements within 35 Feet of Work
Flammable liquids, dust, lint and oily deposits removed.
Explosive atmosphere in area eliminated. Floors swept clean.
Combustible floors wet down, covered with damp sand or fire-resistive sheets.
Remove other combustibles where possible. Otherwise protect with fire-
resistive tarpaulins or metal shields.
All wall and floor openings covered.
Fire-resistive tarpaulins suspended beneath work.
Work on Walls or Ceilings
Construction is noncombustible and without combustible covering or insulation.
Combustibles on other side of walls moved away.
Work on Enclosed Equipment
Enclosed equipment cleaned of all combustibles.
Containers purged of flammable liquids/vapors.
Fire Watch/Hot Work Area Monitoring
Fire watch will be provided during and for 60 minutes after work, including any
coffee or lunch breaks.
Fire watch is supplied with suitable fire extinguishers.
Fire watch is trained in use of this equipment and in sounding alarm.
Fire watch may be required for adjoining areas, above, and below.
Monitor Hot Work area for 4 hours after job is completed.
Other Precautions Taken