[Hotwork] NEW Hot Work Permit Request - Facilities Services and Other Departments
Tracy Stark
tracy.stark at ucr.edu
Tue Mar 25 12:49:58 PDT 2025
Approved. Please have a copy (electronic or paper at the job site.)
Please fill out below and reply all to this email to close the permit.
*------------------------------------------------------------------------------------------------------*
*Select reply all and complete the below information before sending.*
*JOB COMPLETED ON (Please specify DATE and TIME):*
*SUBMITTED BACK TO EH&S (DATE):SUBMITTED BY:*
---------------------------------------------------------------------------------------------------------------------------
*Tracy Stark*
Safety Engineer
UCR Environmental Health & Safety
tracy.stark at ucr.edu
(951) 827-5118
Book time with me on Zoom or in-person here.
<https://calendar.app.google/ARaUNPsZHLaZngta9>
On Tue, Mar 25, 2025 at 12:31 PM Hot Work Program <noreply at qemailserver.com>
wrote:
> [image: Graphic.php?IM=IM_8HvGTwJPt7awyvX]
>
> *HOT WORK PERMIT REQUEST FACILITIES SERVICES AND OTHER DEPARTMENTS*
>
> -----------------------------------------------------------------------------------------------------
> *HOT WORK IS BEING PERFORMED BY: *UC Riverside employee
>
> *PERMIT REQUESTOR:* Daniel mendez
> *DEPARTMENT: *Sheetmetal shop
> *PHONE NUMBER:* 9516084082
> *EMAIL: *Dmendez at ucr.edu
>
> *PROJECT MANAGER/SUPERVISOR: *Cory Gryniuk
> *PHONE NUMBER: *9517436159
> *EMAIL: *Cory.gryniuk at ucr.edu
>
> *PERSON PERFORMING HOT WORK: *Daniel mendez
> *COMPANY/DEPARTMENT: *Sheetmetal shop
> *PHONE NUMBER: *9516084082
>
> *PERSON PERFORMING FIRE WATCH: *Jesse Guzman
> *COMPANY/DEPARTMENT: *Plumbing shop
> *PHONE NUMBER: *9516084087
>
> -----------------------------------------------------------------------------------------------------------------------------
> *JOB DETAILS*
>
> *JOB START DATE: *03/25/2025 12:30pm
> *JOB END DATE: *03/25/2025 2:30pm
>
> *LOCATION - BUILDING/FLOOR/ROOM*: Steam plant
>
> *JOB DESCRIPTION: *
> Weld cover bracket for shaft in the cooling tower
>
>
> *THE FOLLOWING PRECAUTIONS HAVE BEEN ACKNOWLEDGED AND WILL BE IN PLACE
> WHENEVER POSSIBLE (FOR EXCEPTIONS - SEE COMMENTS BELOW)*
>
> *General:*
> Available sprinklers, hose streams, and fire extinguishers are in service
> and operable
> , Hot work equipment is in good repair
> , Fire detection equipment protected from false activation
> , PPE is used to protect workers from physical and chemical hazards while
> hot work is being performed
>
> *Within 35 feet (11 meters) of work: *
> Flammable liquids, dust, lint, and oily deposits are removed/cleaned
> , Explosive atmosphere in area is eliminated
> , Floors are swept and clean
> , Combustible floors are wet down and/or covered with fire protection
> blankets
> , Other combustibles are removed when possible or else covered with fire
> protection blankets or metal shields
> , All wall and floor openings are covered
> , Fire protection blankets are suspended beneath work
> , Ducts and conveyors that might carry sparks to distant combustible
> materials are protected or shut down
>
> *Fire Watch/Hot Work area monitoring: *
> Fire watch will be provided during and for at least 30 minutes after work
> stops
> (including lunch and break times)
> , Fire watch is supplied with suitable fire extinguishers and fire
> fighting equipment
> , Fire watch is trained in the use of fire extinguishing equipment and in
> sounding emergency alarm
> , Additional fire watch may be required in adjoining areas, above, and/or
> below
> , Fire watch will verify isolated fire detection equipment is returned to
> normal operation
>
> *Work on walls, ceilings and/or roofs:*
> Does not apply
>
> *Work on enclosed equipment:*
> Does not apply
>
> *OTHER PRECAUTION(S) TAKEN (IF APPLICABLE): *
>
>
> *COMMENTS (WHY PRECAUTION(S) CANNOT BE PUT INTO PLACE): *
>
>
>
>
>
> * End of Request
> -----------------------------------------------------------------------------------------------------------------------------
> EH&S Approval
> *
>
> *------------------------------------------------------------------------------------------------------*
>
> *EH&S APPROVAL: Tracy Stark *[image: T signature.jpg]
>
>
> *PERMIT START (DATE): * 03/25/2025 12:30pm
>
> *PERMIT EXPIRES (DATE): 3/26/2025*
>
> *APPROVAL SENT TO FS (DATE): 3/25/2025*
>
> *COMMENTS:*
>
>
>
>
>
> ------------------------------
>
> *Recipient Data: *
> *Time Finished:* 2025-03-25 13:31:54 MDT
> *IP:* 166.199.97.13
> *ResponseID:* R_74eBNxdebday4VK
> *Link to View Results:* Click Here
> <https://ucriverside.pdx1.qualtrics.com/apps/single-response-reports/reports/M3tJ6w49eHsGu_jbVqVUfnwc_XzpkotUedieDtQk7_PFUMTZ0eqKS9A-AR9sfvaRZc3Rc3QDztrMlK_amHGn9kR5lwj5Qinl_3pbAQ0RKVGQkCXyuZqTZKsqeJ7yt4K5nXe6gOp9zcwzIcJxu69Mcjgo6UZmIXJofQ3anibKBmW6F1UpFh2rchibEvWUg66TtPePpIaxopaSr6fCRoF_I4vWbxU3tJrOIRFmLEFyehTUP1OfiVcMwQntKR_ep_OdtlJXW7L9syT7DxDjegWGMgcdz9XMqfUUQLW1RBB2rM1hfAp6QPi_Pn9b3KO_DUgLmy60UqIMK7k6zYpxXS5vWA>
> *URL to View Results:*
> https://ucriverside.pdx1.qualtrics.com/apps/single-response-reports/reports/M3tJ6w49eHsGu_jbVqVUfnwc_XzpkotUedieDtQk7_PFUMTZ0eqKS9A-AR9sfvaRZc3Rc3QDztrMlK_amHGn9kR5lwj5Qinl_3pbAQ0RKVGQkCXyuZqTZKsqeJ7yt4K5nXe6gOp9zcwzIcJxu69Mcjgo6UZmIXJofQ3anibKBmW6F1UpFh2rchibEvWUg66TtPePpIaxopaSr6fCRoF_I4vWbxU3tJrOIRFmLEFyehTUP1OfiVcMwQntKR_ep_OdtlJXW7L9syT7DxDjegWGMgcdz9XMqfUUQLW1RBB2rM1hfAp6QPi_Pn9b3KO_DUgLmy60UqIMK7k6zYpxXS5vWA
> ------------------------------
>
> *Response Summary:*
>
> PLEASE SELECT PERMIT TYPE:
> Facilites maintenance and other small projects
>
> PRECAUTIONS CHECKLIST: Note: If necessary, please use the comments area
> below to further explain why a listed precaution cannot be taken in the
> manner described.
> Available sprinklers, hose streams, and fire extinguishers are in
> service and operable
> Hot work equipment is in good repair
> Fire detection equipment protected from false activation
> PPE is used to protect workers from physical and chemical hazards while
> hot work is being performed
>
> WITHIN 35 FEET (11 METERS) OF HOT WORK SITE:
> Flammable liquids, dust, lint, and oily deposits are removed/cleaned
> Explosive atmosphere in area is eliminated
> Floors are swept and clean
> Combustible floors are wet down and/or covered with fire protection
> blankets
> Other combustibles are removed when possible or else covered with fire
> protection blankets or metal shields
> All wall and floor openings are covered
> Fire protection blankets are suspended beneath work
> Ducts and conveyors that might carry sparks to distant combustible
> materials are protected or shut down
>
> FIRE WATCH/HOT WORK AREA MONITORING:
> Fire watch will be provided during and for at least 30 minutes after
> work stops (including lunch and break times)
> Fire watch is supplied with suitable fire extinguishers and fire
> fighting equipment
> Fire watch is trained in the use of fire extinguishing equipment and in
> sounding emergency alarm
> Additional fire watch may be required in adjoining areas, above, and/or
> below
> Fire watch will verify isolated fire detection equipment is returned to
> normal operation
>
> WORK ON WALLS, CEILINGS, AND/OR ROOFS:
> Does not apply
>
> WORK ON ENCLOSED EQUIPMENT:
> Does not apply
>
> HOT WORK BEING PERFORMED BY:
> UC Riverside employee
>
> HOT WORK OPERATOR:
> Name Daniel mendez
> Company/Department Sheetmetal shop
> Mobile Phone Number (###-###-####) 9516084082
>
> FIRE WATCH:
> Name Jesse Guzman
> Company/Department Plumbing shop
> Mobile Phone Number (###-###-####) 9516084087
>
> JOB TIME FRAME:
> Start date 03/25/2025
> Start Time 12:30pm
> End Date 03/25/2025
> End time 2:30pm
>
> LOCATION OF HOT WORK (BUILDING, FLOOR, ROOM, ETC.)
> Steam plant
>
> Project/WO Number:
> 86731
>
> PROJECT/JOB DESCRIPTION:
> Weld cover bracket for shaft in the cooling tower
>
> FACILITIES SUPERVISOR OR UCR PROJECT MANAGER SUPERVISING THIS JOB:
> Name Cory Gryniuk
> Phone Number 9517436159
> Email Cory.gryniuk at ucr.edu
>
> HOT WORK PERMIT REQUESTOR:
> Name Daniel mendez
> Department/Contractor Company Sheetmetal shop
> Phone Number 9516084082
> Email Address Dmendez at ucr.edu
>
>
>
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