Template Examples General permit to work template Free, no account
Permit to Work Permit no. Site Exact location Details Contractor Valid to Issued to RAMS ref Valid from The work Work to be done Plant and equipment Hazards Services Lifting Height Traffic Confined space COSHH substances Hot work Other Precautions Done By What is isolated How Locked Tag Proved by People on this permit: name Company Briefed Other conditions Sign-off Name Signature Date Time Issued: precautions checked Accepted: permit understood Page 1 of 2 Permit to Work Permit no. Site Exact location Cancellation Work stopped at Area checked Equipment removed Handback Isolations removed Area returned to Notes Sign-off Name Signature Date Time Extended: new end time Cancelled: area checked Handed back: area returned Page 2 of 2
Choose a design Hot work permit Hot Work Permit Permit no. Site Exact location Details Contractor Valid to Issued to RAMS ref Valid from Fire risk ref The work Hot work to be done Method Why cold methods fail Hazards Combustibles in 10 m Roof or wall linings Openings and voids Below, behind walls Flammables nearby Sprinklers, alarms Dust or lint Occupied building Precautions Done By Combustibles removed or covered Floors swept, combustible floors covered Openings and voids sealed Non-combustible screens up Detectors isolated: who restores them Gas cylinders secured and checked Two extinguishers within reach: type Fire watcher named, breaks covered How to raise the alarm Hot work ends 2 hours before day end Others shielded from arc and sparks Fume: LEV or RPE Permit shown at the work Equipment Extinguishers Thermal camera Fire blanket Welding screens Hose reel Gas detector Other conditions Sign-off Name Signature Date Time Issued: precautions checked Accepted: permit understood Page 1 of 2 Permit to dig Permit to Dig Permit no. Site Exact location Details Contractor Valid to Issued to RAMS ref Valid from Drawing, date The work Where, depth, method Hand dig zone Hazards Electricity Drains and sewers Water ingress Gas District heating Traffic Water Contaminated ground Services unknown Telecoms Unstable ground Precautions Done By Drawings obtained and dated Scanned with locator and signal generator Services marked on the plan and ground Trial holes hand dug Services exposed and supported Edge protection and ladders in place Spoil kept back from the edge Sides supported or battered Inspected at the start of each shift Gas monitoring, traffic management Services made dead How Locked Tag Proved by People on this permit: name Company Briefed Other conditions Sign-off Name Signature Date Time Issued: precautions checked Accepted: permit understood Page 1 of 2 Confined space entry permit Confined Space Entry Permit Permit no. Site Exact location Details Contractor Valid to Issued to RAMS ref Valid from Isolation cert The work Space and entry point Work to be done Why entry, time limit Hazards Oxygen low or high Heat Toxic gas Drowning Flammable air Restricted entry Engulfment Power, machinery Precautions Done By Space isolated and locked off Cleaned, purged and ventilated Air tested before entry and during Supervisor and top person named Communication agreed Rescue plan and equipment ready Harness and line Safe lighting and tools Breathing apparatus where needed How emergency services are called What is isolated How Locked Tag Proved by Equipment Gas monitor Lighting Tripod and winch Escape BA Radio Other conditions Sign-off Name Signature Date Time Issued: precautions checked Accepted: permit understood Page 1 of 2 Electrical isolation permit Electrical Isolation Permit Permit no. Site Exact location Details Contractor Valid to Issued to RAMS ref Valid from Isolation cert The work Equipment or circuit Work to be done Circuit isolated Point of isolation Lock no. Tag Proved dead by Test instrument Precautions Done By Isolated at the source Locked and tagged Fuses or links held safe Proved dead at the work, tester proved Earthed where needed Equipment marked, danger notices up Adjacent live parts screened Key held by Hazards Live parts nearby Capacitors Stored energy Back-feed Generator, inverter People on this permit: name Company Briefed Other conditions Sign-off Name Signature Date Time Issued: precautions checked Accepted: permit understood Page 1 of 2 Working at height permit Working at Height Permit Permit no. Site Exact location Details Contractor Valid to Issued to RAMS ref Valid from The work Where and how reached Work to be done Why not from ground Hazards Fragile roof Overhead lines Unprotected edge People below Roof lights Lone working Weather Falling objects Precautions Done By Access equipment inspected Edge protection in place Fragile surfaces covered or barriered Harness and anchor points Rescue plan in place Exclusion zone below Weather checked Tools tethered Lighting Equipment MEWP Netting Tower Scaffold Harness People on this permit: name Company Briefed Other conditions Sign-off Name Signature Date Time Issued: precautions checked Accepted: permit understood Page 1 of 2 General permit to work Permit to Work Permit no. Site Exact location Details Contractor Valid to Issued to RAMS ref Valid from The work Work to be done Plant and equipment Hazards Services Lifting Height Traffic Confined space COSHH substances Hot work Other Precautions Done By What is isolated How Locked Tag Proved by People on this permit: name Company Briefed Other conditions Sign-off Name Signature Date Time Issued: precautions checked Accepted: permit understood Page 1 of 2
What a permit to work includes HSE sets no fixed form. Its guidance says the company issuing the permit should design it around the site (HSG250 ).
Two ways to run your permits On paper, from this book Print the two sheets, number them and issue one for each job.
Back to the permit 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 questions What is a permit to work? A written, signed go-ahead for a named high-risk job, at one place, for a set time. It says what the hazards are, what must be in place first, and who is responsible. It supports your safe system of work. It does not replace it. HSE: HSG47 , HSG250 , L101 .
When is a permit to work required? No single rule lists every job. HSE guidance points to one for hot work you cannot avoid, for confined space entry where serious injury is foreseeable, and for high-voltage work. It may suit particularly hazardous digging. Your risk assessment decides. HSE: HSG168 , L101 , HSR25 , HSG47 .
Who issues a permit and who accepts it? A person with clearly assigned authority issues it, after checking the precautions. The person in charge of the work accepts it, confirming they understand the work, the hazards and the precautions. Nobody should issue a permit to themselves. HSE: HSG168 , HSG250 .
Can one permit cover several days? Not as an open-ended go-ahead. A permit covers a clearly defined job at one place for a set time. If the job runs on, use the Extended row: check it is still safe and write the new end time. A new shift needs telling what is still open. HSE: HSG168 , HSG250 .
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