General Access Permit

• Site conducted

  Select

• Permit Number

• Permit Type - Access Only

• CAFM Work Request No.:

• Work specified in the Permit is conditional on all contractors having read, understood and signed the Integral site Induction Pack.

• Company Name:

• Competent person in charge:

• Other personnel engaged in the works?

• Permit Required From:

  Date

• Permit Open Until:

  Date

Description Of Works

• Where will the works take place?

• Description of works?

• Why are the works being carried out?

• Are the proposed works non - intrusive in nature?

  Yes

  No

  N/A

• Do Not Issue Permit, all intrusive works require RAMS to be submitted and a General Work Permit to be issued.

Approvals

• Approved by:

• Add signature

  Sign

• Select date

  Date

Permit Acceptance

• Acceptance: I accept responsibility for the work / personnel stated and agree to implement safe working procedures. I understand the Hazards of this work and the precautions to be taken. These have been fully explained to the operatives carrying out this work and I consider them to be adequately trained and competent. Work will only be undertaken on the job / equipment specified. I will return my copy of this permit to the authorised person when the work has been safely completed. In the event of an emergency I will cease the work safely and comply with the Site Emergency Procedures. Work will only recommence when a new Risk Assessment has been carried out and a new permit issued.

• Accepted by:

• Signature:

• Date:

Declaration by Personnel

• I confirm that I have been briefed about the task(s) to be undertaken under this permit. I understand and accept the Method to be used, the Hazards involved, the Control measures and Safety precautions to be taken and the residual risks.

• I have been provided with sufficient and appropriate PPE , Safety equipment and have been trained in its use.

• Emergency procedures have been explained to me and I understand what to do in an emergency.

• NB. If you are in any doubt regarding any of the safety issues in connection with this job, DO NOT SIGN THIS FORM. Consult your Supervisor, Safety Representative or Safety Officer.

• Name/s of personnel:

• Signatures:

• I accept that the work has been safely completed. This permit is now closed and invalid.

• Closed By:

• Signature:

  Sign

• Date & Time:

  Date

Security Checks

• Permit returned by contractor?

  Yes

  No

  N/A

• Permit closed?

  Yes

  No

  N/A

• Passes Returned?

  Yes

  No

  N/A

• Keys Returned?

  Yes

  No

  N/A

• Signed:

  Sign

• Date:

  Date

• Additional Comments?