LOW VOLTAGE PERMIT TO WORK

Permit Details

• Permit Type:

  Low Voltage Energisation

  Low Voltage Isolation

  Low Voltage Testing

  Low Voltage Equipment Access

• PTW Reference Number:

• Client Name:

• Project Name:

• Contract Number:

Activity To Be Undertaken

• Description of Work Activity:

• Job Sheet No.

• Location of Activity:

• Planned Date & Start Time:

  Date

• Planned Date & Finish Time:

  Date

• Any Special Conditions Associated with Activity

Access Control Measures & Safety Precautions

• Safety Lock Off Precautions in Place

  Yes

  No

  N/A

• Safe Isolation of Supply

  Yes

  No

  N/A

• Prove Apparatus Dead / Test Instruments Used

  Yes

  No

  N/A

• Test Instrument Calibration in Date

  Yes

  No

  N/A

• Earthing / Apparatus Earthed in Place

  Yes

  No

  N/A

• Safety Warning Notices

  Yes

  No

  N/A

• Any Other Safety Precautions / Comments

Authorised Person Issuing This Permit

• In accordance with BS7671:2018 I declare that the above reference permit and associated safety precautions have been taken and have been made known to the authorised /competent person undertaking the works. I consider the apparatus referenced within this PTW is safe to Access/Work on/Test.

  Yes

  No

  N/A

• Full Name:

• Position:

• Signature:

  Sign

• Date & Time of Issue:

  Date

Authorised/Competent Person Accepting This Permit

• I acknowledge receipt of this PTW and understand the safety precautions detailed above. I have witnessed the isolations made/apparatus/circuit(s) have been made dead. All personnel under my supervision/control will be made aware of safety precautions that have been put in place/as detailed within this PTW. In the event of an emergency, myself/all personnel under my control will cease work safely and comply with site workplace emergency procedures. I will return this PTW to the issuing Authorised Person when the works activity as detailed within this PTW has been safely completed. Works as detailed within this PTW will only recommence following receipt of a new PTW.

  Yes

  No

  N/A

• Full Name:

• Position:

• Signature:

  Sign

• Date & Time Received:

  Date

Completion/Closure

• I confirm that the works activity as detailed within this PTW has been completed/closed out and all personnel and equipment has been withdrawn.

  Yes

  No

  N/A

• Full Name:

• Position:

• Signature:

  Sign

• Date & Time of Closure:

  Date

• THIS PTW IS TO BE RETURNED TO THE AUTHORISED PERSON UPON COMPLETION OF THE ABOVE DESCRIBED WORK ACTIVITY FOR CLOSURE.

  Returned

  Not Returned