General Permit to Work

Title Page

Permit number
Company Visiting Site/Performing Work Tasks
Location
Conducted on
Validity - Start Time
Validity - Estimated completion time
Prepared/Arranged by/ Job controller
- Darren Downing
- Charlie Clarke
- Natalie James
- Roger Wilson
- Dave Norton
- Ryan Scott
- Other
Specify other
Hours of Work
Specify Other
Select date
Name of new job controller.

General details

Job details and description.
Tools/machinery to be used
Is any other work currently being undertaken that may interact or effect this permit?
Are measures in place and all effected notified?

Hazards and Precautions to be taken

Are all risk assessments and method statements in place?
RAM's must be in place and task specific before any work starts.
Is the area clean and free from hazards?
Area should be clear of hazards or extra measures in place to reduce the risk. Take pictures as a record and add to permit.
Will the work involve Construction/Demolition? (Additional permits maybe required)
Complete construction permit before starting the job
Will the task involve working at heights? Including MEWP's, scaffold, ladders and roof access. (Additional permits maybe required)
Complete a working at heights permit before starting work.
Ladder training and MEWP licence's in order? Picture evidence maybe taken if required.
Training must be in place before using ladders and MEWP's
Are the weather conditions acceptable?
Does the work involve electrical systems/LV electrical distribution systems?
Can the equipment be isolated and all forms of electricity removed?
Permit to work on live equipment required and completed?
LOTO needed and additional permits required?
Permit completed LOTO in place and system lock off log completed?
Additional permits must be active and LOTO completed before starting tasks.
If LOTO is required which services are to be isolated? (valve no', circuit ref') And lock number applied.
Is LOTO training in place and at the correct level for the task?
LOTO training completed to the appropriate level
Are there pressurised systems and or hazardous fluids/substances to consider?
Are measures in place to prevent injury and any necessary systems isolated or valved off?
Have all feed valves been closed, locked and clearly labelled?
If valves can not be locked or closed other measures should be implemented to prevent accidental release of pressure or hazardous substances. Extra monitoring and additional PPE should be in place.
Is there potential for an explosive atmosphere?
Have all unnecessary personnel/employees been removed to a safe distance? Are measures in place to reduce the risk (removal of flammable items and liquids etc)
Is there a risk from Legionella?
Appropriate PPE to be worn.
Is there a risk of coming into contact with Asbestos?
Appropriate PPE to be worn.
Is there a risk from Ionising and or non Ionising radiation?
Monitoring equipment available (if needed) and appropriate PPE available? Add notes of additional measures in place if required.
Is there a risk of heavy lifting? (manual handling) Or using heavy lifting equipment?
Is the equipment suitable for the lift and LOLER certification in order?
Trained, competent person to be in place and LOLER certification available before work commences.
Have all managers and employees effected by the work been notified and signage put in place?
Managers and employees effected need to be notified before work commences.
Have all workers been assessed as competent to perform the tasks required or closely supervised by someone who is competent?
A competent person must be available for all works.
Is all tooling required in good order and appropriate for the tasks? PAT tested if required?
All tooling must be fit for purpose and PAT tested.
Replace worn, damaged tooling and contact the permit issuer for any PAT testing requirements.
Will excavation be required? (This may require an additional permit)
Fill out excavation permit.
Will the task require entering a confined space? (This will require an additional permit and risk assessment)
Fill out confined space permit. Refer to confined space safe system of work document.
Do atmospheric tests need to be carried out?
Do the test results allow for safe continuation of the required work/tasks?
Do not attempt to enter the area until the test results are within the specified safe parameters. Continue to monitor during the task.
Is breathing apparatus available if required?
Has all motive power been identified and removed or measures in place to prevent injury?
Any potential for motive power must be removed or stops/braces in place before continuing.
Are any hot works to be done? *This will require an additional Hot work permit before work commences.
Fill out hot works permit.
Is the correct PPE available and in good working condition?
Correct PPE to be issued before starting any works.
Is contact with Pets/animals possible or work in Pet areas?
Are individuals trained and inducted in pet interaction and aware of the dangers with foreign body contamination and the risk to animals?
Training/Induction must be in place before working in Pet areas. Individuals should be aware of foreign body risks to pets, for example tooling, equipment debris. The area should be inspected when the tasks are complete.
Is there a risk of product contamination?
Area to be checked by the permit issuer or duty manager. Picture evidence can be taken.
Will the work put anyone in the vicinity of a hazardous area such as a railway track, river, overhead power lines or workplace traffic such as FLT's?
An additional dynamic risk assessment maybe needed? Extra supervision, barriers and additional PPE will be required.
Are there any other hazards or precautions which need to be covered on this permit to perform the tasks safely? Please give full details of tasks and measures in place.

Authorization and 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 work as defined above and the permit information has been explained to all workers involved. I accept responsibility for this work.
Full name of the acceptor and competent person/person in charge
Full Name and Signature of the permit Issuer
Full Name and Signature of Duty manager.
Date and Time

4 HOUR PTW ISSUER CHECKS

PTW Issuer must return to the permit activity area at least every 4hrs, to inspect the area and ensure that the hazards have not changed and the PTW Acceptor and team maintain compliance to the conditions of the PTW.
Tap on '+' to add Check below as many as needed.
Name, Signature & Sign Date
Activity sign on/off - I am aware of the scope, hazards, work limitations and necessary controls. I have understood and accept the conditions stated on the risk assessments and method statements and permit to work. I am competent to complete the work.
Sign On (Name, Signature & Sign Date)
Sign Off (Name, Signature & Sign Date)

Hand Back and Cancellation

I confirm that the work has been completed/partially completed, checked by myself and the area left in a safe and tidy condition.
Full Name and Signature of the acceptor and competent person/persons in Charge
Full name and signature of the permit issuer
Full Name and Signature of Duty manager.
Date and Time