Skip to content

Electrical isolation permit example

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

Get the blank

Choose a permit

Electrical isolation permit example

Changing a sub-main board

A board with two incomers and a generator inlet, with both firms locked on through a lock-out box, proved dead before the permit was issued.

Download PDFDownload ExcelDownload Word

What to change

  • Your site and exact board
  • Every way, lock, tag and the order you did them in
  • Who issues it: the person authorised for this system
  • Whether earths are needed on your board

Sources

Checked

  1. Electrical Isolation PermitHollins & Reed Contracting LtdPermit no.HR-0423SiteUnit 3, Canal Side Business ParkExact locationPlant room, board DB-2DetailsContractorValid toIssued toRAMS refValid fromIsolation certHollins & ReedCallum Whittle26/10/26 08:0026/10/26 16:30HR-RAMS-13ISO-0423The workEquipment or circuitWork to be doneSub-main board DB-2, fed by main switchboard ways 4 and 6, with a generator inlet.Replace DB-2, re-terminate its circuits. No live work. Any change needs a new permit.Circuit isolatedPoint of isolationLock no.TagProved dead byTest instrumentIncomer A, generalMain switchboard way 4L1T1Glen AspinallTester V1, unit P1Incomer B, Tanyard AirMain switchboard way 6L2T2Glen AspinallTester V1, unit P1Generator inletInlet isolator beside DB-2L3T3Glen AspinallTester V1, unit P1PrecautionsDoneByIsolated at the sourceLocked and taggedFuses or links held safeProved dead at the work, tester provedEarthed where neededEquipment marked, danger notices upAdjacent live parts screenedKey held byGlen AspinallGlen Aspinall, box B1Not needed. BreakersGlen AspinallNot needed. See belowCallum WhittleCallum WhittleWhittle, TunnicliffeHazardsLive parts nearbyCapacitorsStored energyBack-feedGenerator, inverterPeople on this permit: nameCompanyBriefedCallum WhittleHollins & ReedKieran TunnicliffeTanyard AirOther conditionsBefore issue: 07:10 ways 4, 6 and inlet isolator off. 07:15 L1 to L3 on, keys in lock-out box B1, Whittle and Tunnicliffe eachlock it, keep their key. 07:18 tags on. 07:25 tester proved on P1. 07:30 DB-2 proved dead, every way and conductor, noback-feed at inlet. 07:50 tester proved again. 07:52 screen, danger notice up at main switchboard. 07:55 issued.Main switchboard stays live. No earths: low voltage, inlet locked, no generator on site.Sign-offNameSignatureDateTimeIssued: precautions checkedAccepted: permit understoodGlen Aspinallsigned26/10/2607:55Callum Whittlesigned26/10/2607:58Worked example of a made-up job. Not a permit. · Page 1 of 2
  2. Electrical Isolation PermitHollins & Reed Contracting LtdPermit no.HR-0423SiteUnit 3, Canal Side Business ParkExact locationPlant room, board DB-2CancellationWork completeTools and earths removedPeople clear15:40. New DB-2 fitted and re-terminated. BS 7671 dead tests done, results on thecertificate.Cleared by Callum Whittle: tools out, covers on. No earths were fitted.Callum Whittle and Kieran Tunnicliffe told the board is going live, 15:48.HandbackLocks removed byRe-energised atTested byNotesCallum Whittle and Kieran Tunnicliffe took their locks off box B1 at 15:50. Glen Aspinall tookoff L1 to L3 at 15:55. Tags and notices off.16:00 way 4, 16:05 way 6, by Glen Aspinall.Callum Whittle: live tests after energising passed. Fans run, checked by Kieran Tunnicliffe.Certificate EIC-0423 in the job file. Screen at the main switchboard down at 16:15.Sign-offNameSignatureDateTimeExtended: new end timeCancelled: area checkedHanded back: area returnedNot extendedGlen Aspinallsigned26/10/2615:48Glen Aspinallsigned26/10/2616:20Worked 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: Electrical Isolation Permit

Hollins & Reed Contracting Ltd

  1. Permit no.HR-0423
  2. SiteUnit 3, Canal Side Business Park
  3. Exact locationPlant room, board DB-2

Details

  1. ContractorHollins & Reed
  2. Issued toCallum Whittle
  3. Valid from26/10/26 08:00
  4. Valid to26/10/26 16:30
  5. RAMS refHR-RAMS-13
  6. Isolation certISO-0423

The work

  1. Equipment or circuitSub-main board DB-2, fed by main switchboard ways 4 and 6, with a generator inlet.
  2. Work to be doneReplace DB-2, re-terminate its circuits. No live work. Any change needs a new permit.

Circuit isolated

  1. Incomer A, generalPoint of isolation: Main switchboard way 4. Lock no.: L1. Tag: T1. Proved dead by: Glen Aspinall. Test instrument: Tester V1, unit P1
  2. Incomer B, Tanyard AirPoint of isolation: Main switchboard way 6. Lock no.: L2. Tag: T2. Proved dead by: Glen Aspinall. Test instrument: Tester V1, unit P1
  3. Generator inletPoint of isolation: Inlet isolator beside DB-2. Lock no.: L3. Tag: T3. Proved dead by: Glen Aspinall. Test instrument: Tester V1, unit P1

Precautions

  1. Isolated at the sourceDone: yes. By: Glen Aspinall
  2. Locked and taggedDone: yes. By: Glen Aspinall, box B1
  3. Fuses or links held safeDone: no. By: Not needed. Breakers
  4. Proved dead at the work, tester provedDone: yes. By: Glen Aspinall
  5. Earthed where neededDone: no. By: Not needed. See below
  6. Equipment marked, danger notices upDone: yes. By: Callum Whittle
  7. Adjacent live parts screenedDone: yes. By: Callum Whittle
  8. Key held byDone: yes. By: Whittle, Tunnicliffe

Hazards

  1. Live parts nearbyYes
  2. Stored energyNo
  3. Back-feedYes
  4. Generator, inverterNo
  5. CapacitorsNo

People on this permit: name

  1. Callum WhittleCompany: Hollins & Reed. Briefed: yes
  2. Kieran TunnicliffeCompany: Tanyard Air. Briefed: yes

Other conditions

  1. Before issue: 07:10 ways 4, 6 and inlet isolator off. 07:15 L1 to L3 on, keys in lock-out box B1, Whittle and Tunnicliffe each lock it, keep their key. 07:18 tags on. 07:25 tester proved on P1. 07:30 DB-2 proved dead, every way and conductor, no back-feed at inlet. 07:50 tester proved again. 07:52 screen, danger notice up at main switchboard. 07:55 issued.
  2. Main switchboard stays live. No earths: low voltage, inlet locked, no generator on site.

Sign-off

  1. Issued: precautions checkedName: Glen Aspinall. Signature: signed. Date: 26/10/26. Time: 07:55
  2. Accepted: permit understoodName: Callum Whittle. Signature: signed. Date: 26/10/26. Time: 07:58

Sheet 2: Electrical Isolation Permit

Hollins & Reed Contracting Ltd

  1. Permit no.HR-0423
  2. SiteUnit 3, Canal Side Business Park
  3. Exact locationPlant room, board DB-2

Cancellation

  1. Work complete15:40. New DB-2 fitted and re-terminated. BS 7671 dead tests done, results on the certificate.
  2. Tools and earths removedCleared by Callum Whittle: tools out, covers on. No earths were fitted.
  3. People clearCallum Whittle and Kieran Tunnicliffe told the board is going live, 15:48.

Handback

  1. Locks removed byCallum Whittle and Kieran Tunnicliffe took their locks off box B1 at 15:50. Glen Aspinall took off L1 to L3 at 15:55. Tags and notices off.
  2. Re-energised at16:00 way 4, 16:05 way 6, by Glen Aspinall.
  3. Tested byCallum Whittle: live tests after energising passed. Fans run, checked by Kieran Tunnicliffe.
  4. NotesCertificate EIC-0423 in the job file. Screen at the main switchboard down at 16:15.

Sign-off

  1. Extended: new end timeName: Not extended
  2. Cancelled: area checkedName: Glen Aspinall. Signature: signed. Date: 26/10/26. Time: 15:48
  3. Handed back: area returnedName: Glen Aspinall. Signature: signed. Date: 26/10/26. Time: 16:20

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.