Working at height 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 blankChoose a permit
- Torch-on felt on a flat roofA propane torch on the roof of an occupied office, with a fire watch to the two-hour check.2 pages, checked 2 November 2026
- Welding a steel beam in a basementMIG welding during a refurbishment, with fume extraction and the office above checked too.2 pages, checked 2 November 2026
- A new drain in a yard, near live servicesHand digging near a cable and a gas pipe, over two days, with inspections after rain.2 pages, checked 2 November 2026
- Entering a foul manhole to join a drainTwo people in a 2.4 m manhole, with gas tests, a top person and a winch at the surface.2 pages, checked 2 November 2026
- A night fit-out in a bank branchA shopfitting team replacing a reception desk and two partitions after closing, with one intruder alarm zone off and security on site.2 pages, checked 2 November 2026
- A roof survey behind a barrierA surveyor and an assistant on a large flat felt roof with roof lights and an open edge, inside a barrier set and struck on the same permit, with wind readings throughout.2 pages, checked 2 November 2026
- Changing a sub-main boardA 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.2 pages, checked 2 November 2026
Working at height permit example
A roof survey behind a barrier
A surveyor and an assistant on a large flat felt roof with roof lights and an open edge, inside a barrier set and struck on the same permit, with wind readings throughout.
What to change
- Your site and exact location
- Why the survey cannot be done from the ground or a platform
- Who issues it and who accepts it
- The wind limit is this job's own. Set yours from your assessment
Sources
- HSG33: Health and safety in roof work
- Work at Height Regulations 2005
- HSE: fragile surfaces
- HSE: roof work
Checked
The same sheet as text
Worked example of a made-up job. Not a permit.
Sheet 1: Working at Height Permit
Hollins & Reed Contracting Ltd
- Permit no.HR-0422
- SiteUnit 5, Canal Side Business Park
- Exact locationFlat roof, south section, inside the barrier
Details
- ContractorHollins & Reed
- Issued toOwen Tattersall
- Valid from22/10/26 07:45
- Valid to22/10/26 12:30
- RAMS refHR-RAMS-12
The work
- Where and how reachedLarge felt roof, concrete deck. Fixed ladder to a hatch inside the barrier, 9 m from the edge.
- Work to be doneSet the barrier. Two-hour condition survey, photos and moisture readings. Strike the barrier.
- Why not from groundPole camera pictures on 15 October could not show if the felt is wet. That needs a meter.
Hazards
- Fragile roofYes
- Unprotected edgeYes
- Roof lightsYes
- WeatherYes
- Overhead linesNo
- People belowYes
- Lone workingNo
- Falling objectsYes
Precautions
- Access equipment inspectedDone: yes. By: Dan Hollins
- Edge protection in placeDone: no. By: Barrier 2 m instead
- Fragile surfaces covered or barrieredDone: yes. By: Barrier, by 08:50
- Harness and anchor pointsDone: no. By: Not needed. No anchor
- Rescue plan in placeDone: yes. By: See below
- Exclusion zone belowDone: yes. By: Keyholder, cones
- Weather checkedDone: yes. By: Readings, sheet 2
- Tools tetheredDone: yes. By: Wrist straps
- LightingDone: no. By: Not needed. Daylight
Equipment
- MEWPNo
- TowerNo
- ScaffoldNo
- HarnessNo
- NettingNo
People on this permit: name
- Owen Tattersall, Joe Penketh: surveyCompany: Hollins & Reed. Briefed: yes
- Reece Ollerton, Priya Shah: barrierCompany: Hollins & Reed. Briefed: yes
Other conditions
- Issuer at the hatch while anyone works. Stay inside the barrier. Stop at a steady 8 m/s, our limit for this job, or on rain.
- Rescue: no harness. Hurt or ill: ring 999, say fixed ladder, may need fire service. Issuer meets them at the hatch.
Sign-off
- Issued: precautions checkedName: Dan Hollins. Signature: signed. Date: 22/10/26. Time: 07:35
- Accepted: permit understoodName: Owen Tattersall. Signature: signed. Date: 22/10/26. Time: 07:40
Sheet 2: Working at Height Permit
Hollins & Reed Contracting Ltd
- Permit no.HR-0422
- SiteUnit 5, Canal Side Business Park
- Exact locationFlat roof, south section, inside the barrier
Weather and equipment checks
- 07:30Wind: 2.4 m/s. By: Reece Ollerton. Result: Read at the hatch, before issue. Dry. Under our limit.
- 07:45Wind: 2.6 m/s. By: Reece Ollerton. Result: All four briefed by the issuer. Barrier team up. Our method for this job: sections and weights hauled through the hatch on a rope, nobody on the ladder while a load moves. Line taped out from the hatch first, sections set from inside it, one setting, one watching. Nobody past the tape.
- 08:50Wind: 2.9 m/s. By: Dan Hollins. Result: Barrier done, weighted, 2 m from edges and roof lights. Team stopped while the issuer walked it. Team down.
- 09:00Wind: 3.1 m/s. By: Joe Penketh. Result: Survey team up. Dry. Under our limit.
- 10:00Wind: 4.4 m/s. By: Joe Penketh. Result: Dry. Both inside the barrier. Issuer at the hatch.
- 11:00Wind: 6.3 m/s. By: Joe Penketh. Result: Wind rising, cloud building. Last readings, then off the roof.
- 11:20Wind: 6.6 m/s. By: Reece Ollerton. Result: Under our limit. Barrier team up. Sections lifted back towards the hatch, nobody past the line. Issuer at the hatch.
- 11:55Wind: 7.1 m/s. By: Reece Ollerton. Result: Last section lowered through the hatch. Team down.
Cancellation
- Work stopped at11:55. Survey done 11:10, barrier struck 11:55. All four down and counted.
- Area left safeHatch shut and locked 12:00. Nothing left on the roof.
- Equipment removedBarrier sections to the van. Cones lifted 12:05.
Handback
- Area returned toThornley Vale Estates Ltd, site keyholder, 12:15
- NotesSurvey report to follow. Not part of this permit.
Sign-off
- Extended: new end timeName: Not extended
- Cancelled: area checkedName: Dan Hollins. Signature: signed. Date: 22/10/26. Time: 12:10
- Handed back: area returnedName: Dan Hollins. Signature: signed. Date: 22/10/26. Time: 12:15
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
Keep the day’s record
Note each permit issued and cancelled in Site Diary, with photos of the area.
Open Site DiaryPermit 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.