ࡱ> <>;[ bjbj~~ 4"bb NNNNNbbb8,b." BDDDDDD$ hN(((hNN}(^NNB(Bsܧ|.0?!?!?!NvTD)hh((((?!B : Ӱֱ State University Open Flame Permit Date Requested __________________________ Number of Attendees ______________ Event Date _________________________ Start Time ____________ End Time _____________ Responsible Person _____________________________________________________________ Email ______________________________________________ Phone ____________________ Event Name ________________________________ Sponsoring Dept/Org. ________________ Location ______________________________________________________________________ Type of Flame: Small Candles  FORMCHECKBOX  Sterno Burners  FORMCHECKBOX  Other Flame (describe) _______________________________________________________ The Office of Environmental Safety & Health strongly recommends against the use of open flames on Ӱֱ State University property. In an effort to reduce the associated risks of open flames, to maximize life safety and to prepare for emergency response, written approval from the Office of Environmental Safety & Health must be obtained. This form must be returned to Environmental Safety & Health. The Responsible Person on this request is identified as; 1. Being responsible for the source of the open flame. 2. Ensures the open flame is attended at all times. 3. Knows the location of fire extinguishers and is proficient in their use. 4. Knows who to contact in case of emergency and how. The Responsible Person listed on this form must assure compliance with and have adequate knowledge in all areas noted on this form. A COPY OF OPEN FLAME APPROVAL MUST BE ON SITE AND PRODUCED UPON REQUEST. TO BE COMPLETED BY Environmental Safety & Health Use of Combustible Materials (proximity to open flames) ________________________________ Fire Extinguisher Types and Locations ______________________________________________ Knowledge of Extinguisher Use ____________________________________________________ Knowledge of Who to Contact in Case of Emergency ___________________________________ Knowledge of Evacuation Procedures _______________________________________________ Additional Comments ____________________________________________________________ _____________________________________________________________________________ Environmental Safety & Health Approval __________________________________________ Date _________________________________________________________________________     )*,:;xyz " p q s ̻|kW&hUhsJ6>*CJOJQJ^JaJ hUhUCJOJQJ^JaJhsJCJOJQJ^JaJ#hUhsJ>*CJOJQJ^JaJ hUhsJCJOJQJ^JaJhUCJOJQJ^JaJ hUhsJCJOJQJ^JaJhsJ5CJOJQJ^JaJ#hUhsJ5CJOJQJ^JaJ#hUhU5CJOJQJ^JaJ*+,yz ! q r   r s [ \ Z gdsJ$a$gdU    5 6 7 E F G [ \ ] k l m q s п᭿oaI/jthUhrqCJOJQJU^JaJhA4CJOJQJ^JaJ/jhUhrqCJOJQJU^JaJ hUh*CJOJQJ^JaJ)jhUh*CJOJQJU^JaJ#hUhsJ>*CJOJQJ^JaJ hUhsJCJOJQJ^JaJ hUhUCJOJQJ^JaJhUCJOJQJ^JaJ hUhCJOJQJ^JaJ # + B  N Y Z \ W X Y [ _`νܯܯ܂ܯܯܯܯܯqqqqqqqܯ hUh1SCJOJQJ^JaJh5CJOJQJ^JaJh4CJOJQJ^JaJ hUhUCJOJQJ^JaJhUCJOJQJ^JaJ h4h4CJOJQJ^JaJh CJOJQJ^JaJ hUhsJCJOJQJ^JaJ#hUh>*CJOJQJ^JaJ, abcDEBC:;$a$gd5$a$gdU &d P gdsJgdsJ`ciCDFABD &9;AtzphsJ5CJOJQJ^JaJhNx5CJOJQJ^JaJ#hUhU>*CJOJQJ^JaJhsJCJOJQJ^JaJ#hUhsJ>*CJOJQJ^JaJhUCJOJQJ^JaJh45CJOJQJ^JaJ#h hsJ5CJOJQJ^JaJ hUhsJCJOJQJ^JaJ&hcjhcUh5CJOJQJ^JaJ $a$gd5 21h:p5/ =!"#$`% tDeCheck1tDeCheck2s2&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH @`@ sJNormalCJ_HaJmH sH tH DA`D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 44 Header  !4 4 Footer  !HH '4 Balloon TextCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< "  `   6F\l G$G$8@0(  B S  ?Check1Check27] Gm [[[[[[[[ ++28  17BB 9*urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceType=*urn:schemas-microsoft-com:office:smarttags PlaceName MS  YYv & 9 ; A t z )y YYv & 9 ; A t z  YYv & 9 ; A t z  F M >1SVd|AgGoh wNxWSzgYA4;WAG}uI5'48cUkrq*4EsJ @ @UnknownG*Ax Times New Roman5Symbol3. *Cx Arial5. .[`)TahomaACambria Math"1hT'T'yl l !4 3QHP ?sJ2!xx#c UNIVERSITY OF MISSOURI-COLUMBIA RiddlemoserR Susan MillerOh+'0 ,8 X d p | UNIVERSITY OF MISSOURI-COLUMBIARiddlemoserRNormalSusan Miller2Microsoft Office Word@@+}@.T@.Tl ՜.+,0  hp|     8 UNIVERSITY OF MISSOURI-COLUMBIA Title  !"#$%&'()*,-./012456789:=Root Entry FZ觲?Data 1Table?!WordDocument4"SummaryInformation(+DocumentSummaryInformation83CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q