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Permit to work examples

Completed permits for common jobs: both sheets, filled in and cancelled. Read one, download it, then issue your own from the blank.

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Roofing hot work permit example

Torch-on felt on a flat roof

A propane torch on the roof of an occupied office, with a fire watch to the two-hour check.

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What to change

  • Your site and exact location
  • The precautions that do not apply, and why
  • Who issues it and who accepts it

Sources

Checked

  1. Hot Work PermitHollins & Reed Contracting LtdPermit no.HR-0417SiteUnit 3, Canal Side Business ParkExact locationFlat roof over the offices, north endDetailsContractorValid toIssued toRAMS refValid fromFire risk refHollins & ReedPriya Shah12/10/26 08:0012/10/26 17:00HR-RAMS-07HR-FRA-03The workHot work to be doneMethodWhy cold methods failTorch-on felt cap sheet to 30 m² of flat roof, with parapet upstands and two outlets.One torch, one cylinder. Laps rolled. Upstands on low flame, gaps behind sealed first.Cold-applied sheet and a heat gun failed a test patch on 9 October. Neither bonded.HazardsCombustibles in 10 mRoof or wall liningsOpenings and voidsBelow, behind wallsFlammables nearbySprinklers, alarmsDust or lintOccupied buildingPrecautionsDoneByCombustibles removed or coveredFloors swept, combustible floors coveredOpenings and voids sealedNon-combustible screens upDetectors isolated: who restores themGas cylinders secured and checkedTwo extinguishers within reach: typeFire watcher named, breaks coveredHow to raise the alarmHot work ends 2 hours before day endOthers shielded from arc and sparksFume: LEV or RPEPermit shown at the workPriya ShahPriya ShahPriya ShahNot needed. Open roofDan Hollins, zone 3 onlyPriya ShahTwo 9 kg dry powderReece OllertonBreak glass, ring 999Not needed. No arcNot needed. OutdoorsEquipmentExtinguishersThermal cameraFire blanketWelding screensHose reelGas detectorOther conditionsCylinder on a heat-insulating base, 3 m from the torch. Never use water on a bitumen fire.Zone 3 goes back on for any break and when hot work ends. Client told first. Site office 0161 496 0142.Sign-offNameSignatureDateTimeIssued: precautions checkedAccepted: permit understoodDan Hollinssigned12/10/2607:50Priya Shahsigned12/10/2607:55Worked example of a made-up job. Not a permit. · Page 1 of 2
  2. Hot Work PermitHollins & Reed Contracting LtdPermit no.HR-0417SiteUnit 3, Canal Side Business ParkExact locationFlat roof over the offices, north endWhenTimeByResultFire watch: continuous for 1 hour, then a check at 2 hoursDuring breaksEnd of hot work1 hour after the end2 hours after the end12:15 to 12:45Reece OllertonTorch off for the break. Watched roof andvoid. Nothing found.14:45Reece OllertonTorch off, cylinder shut. Continuous watchstarted.15:45Reece OllertonWatched roof and void the whole hour.Thermal image shows no hot spots.16:45Dan HollinsRoof and roof void checked. Nothing found.CancellationWork stopped atArea checked, images keptDetectors restored byEquipment removed14:45 on 12 October. Cap sheet finished.Roof and roof void walked at 16:45. Three thermal images in the job file.Dan Hollins. Back on 12:15, off again 12:45, back on 14:50. Panel normal.Torch, hose and cylinder off the roof by 15:20.HandbackArea returned toNotesThornley Vale Estates Ltd, site keyholderOutlets open again. Nothing to report.Sign-offNameSignatureDateTimeExtended: new end timeCancelled: area checkedHanded back: area returnedNot extendedDan Hollinssigned12/10/2616:50Dan Hollinssigned12/10/2616:55Worked example of a made-up job. Not a permit. · Page 2 of 2

The same sheet as text

Worked example of a made-up job. Not a permit.

Sheet 1: Hot Work Permit

Hollins & Reed Contracting Ltd

  1. Permit no.HR-0417
  2. SiteUnit 3, Canal Side Business Park
  3. Exact locationFlat roof over the offices, north end

Details

  1. ContractorHollins & Reed
  2. Issued toPriya Shah
  3. Valid from12/10/26 08:00
  4. Valid to12/10/26 17:00
  5. RAMS refHR-RAMS-07
  6. Fire risk refHR-FRA-03

The work

  1. Hot work to be doneTorch-on felt cap sheet to 30 m² of flat roof, with parapet upstands and two outlets.
  2. MethodOne torch, one cylinder. Laps rolled. Upstands on low flame, gaps behind sealed first.
  3. Why cold methods failCold-applied sheet and a heat gun failed a test patch on 9 October. Neither bonded.

Hazards

  1. Combustibles in 10 mYes
  2. Openings and voidsYes
  3. Flammables nearbyYes
  4. Dust or lintNo
  5. Roof or wall liningsYes
  6. Below, behind wallsYes
  7. Sprinklers, alarmsYes
  8. Occupied buildingYes

Precautions

  1. Combustibles removed or coveredDone: yes. By: Priya Shah
  2. Floors swept, combustible floors coveredDone: yes. By: Priya Shah
  3. Openings and voids sealedDone: yes. By: Priya Shah
  4. Non-combustible screens upDone: no. By: Not needed. Open roof
  5. Detectors isolated: who restores themDone: yes. By: Dan Hollins, zone 3 only
  6. Gas cylinders secured and checkedDone: yes. By: Priya Shah
  7. Two extinguishers within reach: typeDone: yes. By: Two 9 kg dry powder
  8. Fire watcher named, breaks coveredDone: yes. By: Reece Ollerton
  9. How to raise the alarmDone: yes. By: Break glass, ring 999
  10. Hot work ends 2 hours before day endDone: yes
  11. Others shielded from arc and sparksDone: no. By: Not needed. No arc
  12. Fume: LEV or RPEDone: no. By: Not needed. Outdoors
  13. Permit shown at the workDone: yes

Equipment

  1. ExtinguishersYes
  2. Fire blanketYes
  3. Hose reelNo
  4. Gas detectorNo
  5. Thermal cameraYes
  6. Welding screensNo

Other conditions

  1. Cylinder on a heat-insulating base, 3 m from the torch. Never use water on a bitumen fire.
  2. Zone 3 goes back on for any break and when hot work ends. Client told first. Site office 0161 496 0142.

Sign-off

  1. Issued: precautions checkedName: Dan Hollins. Signature: signed. Date: 12/10/26. Time: 07:50
  2. Accepted: permit understoodName: Priya Shah. Signature: signed. Date: 12/10/26. Time: 07:55

Sheet 2: Hot Work Permit

Hollins & Reed Contracting Ltd

  1. Permit no.HR-0417
  2. SiteUnit 3, Canal Side Business Park
  3. Exact locationFlat roof over the offices, north end

Fire watch: continuous for 1 hour, then a check at 2 hours

  1. During breaksTime: 12:15 to 12:45. By: Reece Ollerton. Result: Torch off for the break. Watched roof and void. Nothing found.
  2. End of hot workTime: 14:45. By: Reece Ollerton. Result: Torch off, cylinder shut. Continuous watch started.
  3. 1 hour after the endTime: 15:45. By: Reece Ollerton. Result: Watched roof and void the whole hour. Thermal image shows no hot spots.
  4. 2 hours after the endTime: 16:45. By: Dan Hollins. Result: Roof and roof void checked. Nothing found.

Cancellation

  1. Work stopped at14:45 on 12 October. Cap sheet finished.
  2. Area checked, images keptRoof and roof void walked at 16:45. Three thermal images in the job file.
  3. Detectors restored byDan Hollins. Back on 12:15, off again 12:45, back on 14:50. Panel normal.
  4. Equipment removedTorch, hose and cylinder off the roof by 15:20.

Handback

  1. Area returned toThornley Vale Estates Ltd, site keyholder
  2. NotesOutlets open again. Nothing to report.

Sign-off

  1. Extended: new end timeName: Not extended
  2. Cancelled: area checkedName: Dan Hollins. Signature: signed. Date: 12/10/26. Time: 16:50
  3. Handed back: area returnedName: Dan Hollins. Signature: signed. Date: 12/10/26. Time: 16:55

What a completed permit shows

  • Who issued it and who accepted
  • What was checked first, and what did not apply
  • The record while it ran (fire watch, gas tests, inspections)
  • How it was cancelled and handed back

Two ways to run your permits

On paper, from this book

Print the two sheets, number them and issue one for each job.

Get the blank

Keep the day’s record

Note each permit issued and cancelled in Site Diary, with photos of the area.

Open Site Diary

Permit to work example questions

Are these real permits?

No. Every job, company, person and address here is made up, and so is every reading. They show what goes in each box.

Can I issue one of these as it is?

No. A permit is written for one job, one place, one time. Issue your own from the blank, after checking the place yourself.

What makes a permit invalid?

It covers only the job, the place and the time written on it. If the time runs out or the work changes, stop, then extend it or issue a new one once it is checked as safe. HSE: HSG250.

How long does a hot work fire watch last?

At least an hour of continuous watching after the hot work ends, then at least one more check two hours after the end. HSE: HSG168.

Where is the blank?

On the permit to work template page. Add your logo, then print it or download it.