Hot Work Permit Incident Report

General Information

Incident Number Report Date Location Hot Work Permit Number

Personnel Involved

Reported By Hot Worker Name Supervisor Name

Incident Details

Incident Date Incident Time Description of Incident Immediate Actions Taken

Injuries & Damage

Was anyone injured? Yes No Injury Details Was property damaged? Yes No Damage Details

Investigation

Probable Cause Corrective and Preventive Actions

Investigator Name Investigation Date