<p> Corresponding permit to work No. A HOT WORK CERTIFICATE (Only to be completed by authorised persons) Specify location Specify likely ignition sources</p><p>OPERATIONAL INFORMATION I have checked, the workplace and reviewed the hazardous areas, and; Yes No  It is free of flammable materials  Sewer and drain systems, and other low lying areas are protected against sparks  The working area is defined with barriers/ signs  Additional fire fighting materials are present and ready for use  A continuous gas detector is installed  A safety guard is continuously present</p><p>GAS TEST (Only to be completed by an AGT) Test frequency: Tick if applicable Once before commencement of the work (minute/hourly repeat Test while work is in progress, at specified frequency frequency)</p><p>The following working area has been tested for flammable gases/vapours:</p><p>Gas test acceptable results: </p><p>Acceptable results have to be agreed with the AGT and LPI:</p><p>Substance Hydrocarbon Oxygen Other, specify Maximum % of the LEL % Vol ppm Minimum N/A %Vol N/A</p><p>Gas tests performed I confirm that I have tested for gas and/or oxygen and that the results are within the specified acceptance levels, and that the measured concentration of explosive gasses/vapours is below the 0% LEL Date Time AGT Signature</p><p>Validity of the Hot Work Permit</p><p>PI: Permit Holder Hot work as described in the Permit to Work is allowed I certify that I am aware of the between: planned work and the precautions From: detailed on the Permit documents and will ensure that work only Until: proceeds when the conditions set Name: out in the documentation are met. </p><p>Signature PI: Signature:</p><p>Date / Time: Date:</p><p>Form A – Hot Work Certificate Permit to Work System Page 1 of 1</p>