Title Page

  • Conducted on

  • Prepared by

  • Location



  • What works will be undertaken?

  • Special Tools / Equipment to be Used

  • Job Location / Plant Identification Number

  • Is any other work currently being undertaken that may interact or affect this permit? (Quote Permit numbers where applicable)

This Permit is only Valid when all sections are complete. If you are in doubt or don't understand, then please ask. Remember, all accidents are preventable and it is people who get hurt and suffer pain. Please use this permit in the spirit intended to protect yourself and others. Please ensure that you sign this permit to work. DO NOT PROCEED WITH YOUR WORK UNTIL YOUR PERMIT HAS BEEN AUTHORISED BY THE RELEVANT MEMBER OF STAFF.


PRIMARY HAZARDS - Asbestos exposure / Mesothelioma / Plural Plaque / Asbestosis / Asbestos Contamination to Site and Products

Please answer the questions truthfully

  • Are you Qualified / Trained to undertake this work?

  • Are you Asbestos Awareness Trained?

  • Have you consulted the Site Asbestos Register for the work location?

  • Does the Work involve any process which may liberate asbestos fibres into the air? Cutting / Drilling / Breaking into Asbestos coatings / Sweeping etc?

  • Please describe the type of Asbestos Containing Material e.g Coatings (Limpet / Paint / Artex Plaster) Asbestos Insulation Board (AIB / Asbestolux) Asbestos Cement / OTHER - CALMEC Toilet Tanks / Seats / Vinyl Floor Tiles / Gaskets / Fuse Flash Pads

HSE Licensed Tasks

  • Is the Work a HSE Licensed Task Listed Below? 1. Removing sprayed coatings (limpet asbestos) <br>Removal or other work which may disturb pipe lagging <br>2. Any work involving loose fill insulation Work on millboard <br>3. Cleaning up significant quantities of loose/fine debris containing ACM dust (where the work is not sporadic and of low intensity, the control limit will be exceeded or it is not short duration work) <br>4. Work on AIB, where the risk assessment indicates that it will not be of short duration<br>

  • If the work is Licensed - are you HSE Registered as Licensed Asbestos Company?

Licensed Work can only be undertaken by HSE Licensed Contractor - STOP WORK IF LICENCE IS NOT PRESENT ON SITE.

Non-licensed Tasks

  • Is the Work as HSE Non-Licensed Task Below? 1. Small, short duration maintenance tasks where the control limits will not be exceeded (Under 2 Hours) or less than 1 hour per day for 7 consecutive days.<br>2. Removing textured decorative coatings by any suitable dust-reducing method.<br>3. Cleaning up small quantities of loose/ fine debris containing ACM dust (where the work is sporadic and of low intensity, the control limit will not be exceeded and it is short duration work). <br>4. Work on asbestos cement products or other materials containing asbestos (such as paints, bitumen, resins, rubber, etc) where the fibres are bound in a matrix which prevents most of them being released (this includes, typically, aged/weathered AC).<br>5. Work associated with collecting and analysing samples to identify the presence of asbestos.

  • Do you have a copy of the HSE Asbestos Essentials Method Statement for the works you will be undertaking?

  • Do you have the equipment required in the Asbestos Essentials Method Statement? i.e. H Rated Vacuum Cleaner / Dust Extraction Equipment.

  • Is an Air Clearance Test required following works?

  • Have all employees got Type 5 Particle Proof PPE - Suits and Boot Covers?

  • Have all employees got FFP3 Half Masks (RPE) to protect against Asbestos Fibres?

  • Have all employees had an up-to-date Face Fit Test for RPE?

  • Are all employees using RPE Clean Shaven? If No - Work is not Permitted as Mask will not provide protection.

  • Are UN Approved Asbestos Removal Bags present for safely removing waste?

  • Is the Double Bag System in use for waste? Red Inner Bag / Clear Overpack Bag?

  • Do you have a Copy of HSE Asbestos Essentials EM1 Emergency Procedure with you on site?


  • Other Precautions Required to undertake the work safely:

  • Other Safety Equipment required to undertake the work safely:

AUTHORISATION & ACCEPTANCE - I confirm that I have verified the above information and ensured that the necessary precautions have been taken. It is safe to carry out the works as defined above and the permit has been explained to all workers involved. I accept responsibility for this work.

  • Person in Charge of Works

  • Company

  • Signature

  • Authorising Person


  • Permit Expires on


  • Name of Person Undertaking Air Clearance Test

  • Air Clearance Result (WEL is 1 Asbestos Fibre /m3 Air)

  • Work Area is safe for persons to enter as WEL has not been exceeded.

BOHS P404 Air Clearance Test is required after licensed tasks or if there has been a risk of contamination to an area, due to liberation of asbestos fibres.


I confirm that the work has been completed, checked by myself, all Asbestos Waste has been correctly packaged and disposed of via a Licensed Waste Contractor and the area left in a safe and tidy condition.

  • Person in Charge (Print Name)

  • Person in Charge (Signature)

I have inspected the completed work, confirmed that Asbestos Waste has been correctly disposed of, and the area has been subject to Air Clearance Test if required and certified as safe. I hereby cancel this permit.

  • Authorised Person (Print Name)

  • Authorised Person (Signature)


  • Permit Cancelled

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.