Contract: File: Version: BROOKFIELD Commercial Operations Document1 3/December 2012 10.2.OH.I.RC.Permit - Hot and or Dust Work Section 1 - To be completed before works are undertaken Site Name Site Address Permit # Contractor Company Contact # Work Location/Description Date/s Valid Time In/Out # of workers The following conditions / Precautions are to be observed All floor & wall openings within 11m must be covered to prevent transmission of sparks Smoke detectors must be isolated in the work area and procedures followed. Barricades, warning signs & spark/flash screens must be provided and utilised. All combustible materials located within 11m must be removed or made safe with non-combustible curtains, metal guards or flame proof covers. Work area, trenches, pits, etc. must be clear of flammable liquids, gases, or vapours The contractor must supply fire safety equipment available for use The person carrying out the hot work must be trained in using the Fire Extinguishers/Hose Reel and in raising/sounding the Alarm The hot work area and any adjoining areas must be patrolled from the start of work and a further minimum 30 minutes after the work has completed Check the box when the item has been completed. Permit shall not be issued until the following precautions have been checked. Means other than Hot Work or moving to a safer location have been considered. Hot work equipment in good repair. All walls, ceilings, or floors being worked on are of non combustible construction (including internally). All floor and wall openings within 11 metres of the operation have been tightly covered. Sprinklers, where provided, are operational and will not be taken out of service while this work is being done. Ample portable extinguishing equipment such as hose lines or extinguishers have been provided. Located: ___________________________________ All combustibles have been relocated 11 metres (further for elevated work) from the operation including areas on opposite sides of walls if heat can be transferred to them through the work piece, any which cannot be moved are protected with metal guards or fire retardant tarpaulins. A fire watch has been assigned to watch for fires or the potential for fires in the work area, on floors above and below, and on the opposite side of walls. This watch shall continue during any lunch or rest period and for at least one hour after the work has been completed. The work will be confined to the area or equipment specified on this permit. Surrounding floors have been swept clean, and if combustible, wet down where possible. No combustible fibers, dusts, vapors, gases, or liquids in the area. Tanks and equipment previously containing such have been purged. Where normally present, the absence of gases or vapors has been verified by a combustible gas detection instrument. If there is a possibility of a leak developing in nearby piping, equipment, or tanks, area is continuously monitored. The proposed works do not have the potential to become a nuisance to the property and the area has been inspected for the presence of any building air intake systems. In the event that the works can become a nuisance and/or there are building air intake systems present, a property impact minimisation plan has been agreed with the facility manager. Brookfield Commercial Operations, 2012. R. McKee Total pages 2 1 Contract: File: Version: BROOKFIELD Commercial Operations Document1 3/December 2012 If it is necessary to isolate the fire detection system, the form 10.2.OH.I.RC.Permit - Fire Impairment is to be completed Fire Watcher Name Company Contact Approvals I certify that the worksite and adjacent areas have been inspected by me and declared safe for hot works to proceed. I understand that the area shall be monitored for 60 minutes after completion of the job and thoroughly inspected at the end of 60 minutes. I have arranged for the fire panel to be isolated, where applicable, and all other necessary precautions taken. After the 60 minute period, additional intermittent patrols should be made for an additional three hours (four hours total after hot work ceases). Name of competent person Signature Date Precautions listed above have been reviewed, ticked and taken, the work area has been examined and the permit is authorised for this Hot Work. Permit issued and reviewed by (Brookfield Staff) Date / Time Senior Staff Member (Brookfield Staff) Date / Time Section 2 - To be completed after works and fire watch are complete This section to be completed and the permit returned on the completion of the works conducted Work was completed Time/Date Work site checked Time/Date FINAL CHECK: I certify that the area has been patrolled for a minimum 30 minutes at the completion fo the work and no fire conditions were noted. The site is now safe and able to resume normal operation Work area and all adjacent areas to which sparks and heat may have spread including floors above and below and on opposite sides of the walls were inspected after the final patrol (four hours after the hot work ceases) is made. Authorised and Competent Person (Competent Person) Date / Time Important Information: All requests require authorisation from Brookfield Commercial Operations prior to works being carried out Fire zones shall not be left isolated overnight For Fire Zone Isolations – Form 10.2.OH.I.RC.Permit - Fire Impairment must be completed in addition to this form Brookfield Commercial Operations, 2012. R. McKee Total pages 2 2