Building_____________ Room#________________

Type of work to be performed:_______________________________________

Date:________________ Time: From_________to_________

Contractor Performing the Hot Work:________________________________________________

On-site Liason:_______________________________________Phone#______________________

EH&S Staff Issuing Permit:_____________________________Phone#______________________

Remember: *All Hot Work Permits must be called into Power Plant Base prior to work commencement. (Phone #2-3444)

*All completed Permits must be sent to EH&S in Chemistry B73.