Hot Work Permit Application – Environmental Health and Safety

Requestor First Name *

First Name

Requestor Last Name *

Last Name

Requestor Email *

Requestor Phone

Requestor Emergency Phone *

University Work Order Number *

University Project Number *

Building Number *

Building Name *

Hot Work Location(s) *

Hot Work to be Completed By *

University Employee

Contractor

DFCM Training Completion Date: *

Contractor First Name *

Contractor Last Name *

Contractor Email *

Contractor Phone

Contractor Emergency Phone

Nature of Hot Work *

Will Hot Work Affect Fire Systems? *

Yes

No

If Yes, Enter Fire Systems Work Order # for Shutdown

Note: If fire detection systems have been affected, Fire Systems MUST be notified when Hot Work is completed - 801-585-1301

Requested Hot Work Start Date:

Start Time

Requested Hot Work End Date

End Time

Requested Start and End Date/Time Details (if needed)

By clicking here, All parties shown above agree to comply with the University of Utah Hot Work Permit Guidelines as outlined in the above document. All parties shown above do hereby certify that employees performing hot work have received training related to such work and are trained in the use of portable fire extinguishers.

Captcha