General Permit to Work Template

This general permit to work template covers the entire Permit to Work System. Start by recording job details, tools and equipment to be used, and other work which may affect the tasks at hand. Next clearly identify tasks which are considered hazardous. You may conduct a risk assessment to evaluate uncontrolled or undetected hazards present on site. After which, ensure that precautions are being taken such as wearing proper PPE. Next endorse the Permit to Work to the Authorizing Officer for review before commencing work. Ensure that the permit information has been explained to all workers involved. Complete the audit by confirming that all necessary processes were rolled out and that it is safe to carry out the work defined. After the task is accomplished hand back the audit to the Authorizing personnel for confirmation and future reference.

Title Page

Permit No.
Contracting Company
Location
Conducted on
Prepared by

General details

Job details
Tools to be used
Is any other work currently being undertaken that may interact or affect this permit?
Specify other work

Hazards and Precautions to be taken

Are the weather conditions acceptable?
Is the area clean and free from hazards?
Is the plant or system isolated and free from every source of danger?
Have all feed valves been closed and locked?
Is adequate signage displayed?
Have all workers been assessed as competent or closely supervised by someone who is competent?
Are tools repaired or replaced when needed.?
Have atmospheric tests been satisfactorily carried out?
Has the electrical supply been switched off?
REFERENCE: Electrical supply switched off
[This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]
Is breathing apparatus available?
Are PPE available and in good working condition?

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 and Signature of Person in Charge
Full Name and Signature of Authorizing Person
Date and Time

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 Person in Charge
Full Name and Signature of Authorizing Person
Date and Time