Permit Request • CampusOptics

A Hot Work Permit is required for any work on campus which involves cutting or welding with open flame torches. This form is to be filled out in its entirety by the responsible party, supervising the Hot Work, and then provided to the UofM Office of Facilities Development for approval, prior to beginning the work.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Name* Required

Additional Location Details

General Information

Company responsible for Hot Work* Required

Company Hot Work Supervisor* Required

Supervisor Phone Number* Required

Hot Work Description* Required

Can this work be done in the shop* Required

Location Questions

Has UofM Electronics shop been contacted to avoid accidental activation of fire alarms?* Required

Has Hot Work area been inspected by all signatories?* Required

Is the Hot Work area fully sprinklered?* Required

Will the Hot Work create fumes and/or smoke?* Required

Does the area have adequate ventilation?* Required

Will forced air ventilation be used?* Required

Will the area be considered an concealed space?* Required

Are combustibles 35 feet from the Hot Work?* Required

Are the combustibles less than 35 feet covered with fire rated materials?* Required

No gasses/vapors have been confirmed by a combustible gas detection instrument?* Required

Are wall and floor openings within 35 feet covered?* Required

Are floor clean and free of combustibles?* Required

Workers will be wearing appropriate Personal Protective Equipment.* Required

Is the work confined to the area described in this permit?* Required

Are warning signs posted in areas subject to passers-by?* Required

Has all Hot Work equipment been inspected and found safe for use?* Required

Is a minimum 2A:2BC fire extinguisher within 30 feet of the Hot Work?* Required

Is Fire Sentry scheduled to be present during the Hot Work?* Required

Has Fire Sentry been trained in use of the fire extinguisher?* Required

Is Fire Sentry scheduled to be present for 60 minutes after completion of Hot Work?* Required

Fire Sentry Name and Phone Number* Required

Sign off

I attest that the above precautions have and will be taken. (sign your name)* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files