Title Page
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Permit number
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Site conducted
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Conducted on
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Prepared by
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Location
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Sub-contractor
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PART 1 - PERMIT HOLDERS DETAILS
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Confirm specific risk assessment and method statement for works being undertaken - Cilantro AP to review and approve.
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Permit Holder Name
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Phone Number
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Email Address
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PART 2 - AUTHORISATION FOR WORKS TO COMMENCE
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The above-named person has been competency checked and is hereby given permission to carry out the work described in the controlled area and on the equipment detailed below.
WORK MUST NOT BE CARRIED OUT IN ANY OTHER AREA OR ON ANY OTHER EQUIPMENT.
TREAT ALL OTHER EQUIPMENT AS DANGEROUS -
Dead testing - Circuits and location
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EIF.05 QA inspection completed and verified to allow live testing to commence <br><br>(For LIVE TESTING) IF NO DO NOT PROCEED WITH LIVE TEST
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Dead test results recorded on NICEIC certificate and verified: <br><br>(For LIVE TESTING) IF NO DO NOT PROCEED WITH LIVE TEST
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LIVE Testing - Circuits and location
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*Note- LIVE TESTING of Ze at origin of LV system is not authorised by this permit. SMS 934 Live testing Risk Assessment to be used.
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Names of any other persons in the testing party:
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Points at which system is isolated. Where Safety Locks have been fitted:
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Other:
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Points at which the system is earthed:
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Other:
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Other precautions in place
- Barrier and Testing No Access Sign in front of the door
- Testing No Access Sign & Barriers Limiting Access to the testing points(s)
- Testing No Access Sign & Barriers Limiting Access to all Testing premises
- Warning signs to be displayed along the circuits before energisation
- Only The persons stated on the permit are allowed in the testing area
- Other (Please state below)
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Keys /Padlocks Issued:
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Cilantro AP Signature
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Select date
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PART 2 - RECEIPT
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I declare that I accept responsibility for carrying out the work on the equipment detailed in this Sanction for Test and that no attempt will be made by me, or by the persons under my control, to carry out work on any other circuits, systems or equipment. All works to be carried out as per IET Guidance Note 3 BS7671 2018.
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Notes/ comments
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Sub-Contractor Signature
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Select date
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PART 3 - CLEARANCE
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I hereby declare that all persons under my charge have been withdrawn and warned that the Sanction for Test permit has been cancelled and that all equipment has been left isolated and locked off unless specifically stated below due to an Authorised Request For Power.
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Notes/ comments
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Sub-Contractor Signature
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Photo to confirm area is safe/ Locked
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Select date
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PART 4 - CANCELLATION
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I hereby declare this Sanction for Test cancelled and all associated keys returned.
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Notes/ comments
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Cilantro AP Signature
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Select date
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PERMIT HOLDER: The Responsible Person in charge of the work to be carried out.
This permit must not be used in situations where a Permit to Work or Limitation of Access is required.
It is the responsibility of the permit holder to ensure:
That they understand the work activity to be carried out and recognise the hazards to be avoided.
That they have read the content, signified to the Authorised Person that they fully understand the instructions and accepted responsibility for carrying out the work by signing Part 2.
That no approach will be made, or work carried out in any other controlled area or associated equipment, by the permit holder or anyone under their control.
That no unauthorised persons are allowed into the restricted area covered by this permit.
That any doors to restricted areas are locked at all times when the area is left unoccupied. All keys and padlocks issued under this permit are under the sole control of the permit holder.
That the restricted area is secured on completion of the work or at the end of the shift and left in a clean and tidy state with all materials removed.
That the permit is always to be displayed by the permit holder on the armband issued to them and is not to be taken from the site.
The permit Part 3 Clearance is signed by the permit holder and returned with any associated keys to the Authorised Person at the designated site permit office on completion of the works / at the end of the shift within the specified times. Part 4 Cancellation will then be completed by the Authorised Person and any keys and padlocks signed back in.
