Permit to Work - Hot Works

• Site conducted

  Select

• Document No.

All accidents are avoidable. You have a responsibility to safeguard yourself and others who may be affected by your actions. No work must take place until this Permit has been completed in full and signed by an Authorised Person.

Section1: Site and Location

• Site/Location

• Contractor

• Brief description of work

• Conducted on

  Date

• Prepared by

• Names of Engineers

Section 2: Precautions and Control Measures

• Fire alarm system zones isolated & smoke heads covered?

  Yes

  No

• Fire suppression system isolated/locked off?

  Yes

  No

• All ancillary services (electric/water/gas) isolated as required?

  Yes

  No

  N/A

• Landlord/Insurers and any other parties that may be affected informed of work?

  Yes

  No

  N/A

• Area cleared of flammable & combustible materials or other suitable precautions taken?

  Yes

  No

  N/A

• Local fire fighting equipment available? (fire extinguishers, fire blankets, etc.)

  Yes

  No

  N/A

• Temporary means of raising/communicating the alarm in place?

  Yes

  No

• Risk Assessments/Method Statements attached to Permit?

  Yes

  No

• All personnel involved understand the local Emergency Procedures?

  Yes

  No

• Safe means of escape maintained?

  Yes

  No

If the answer to any of the applicable questions is 'no' then you must not authorise the permit, but take corrective actions. If you are unsure about any aspect then you should not authorise the permit and seek further advice/guidance.

• Fire Watch required for (mins) after completion of the works

• Fire watch started:

  Date

• Person in charge of fire watch:

  Sign

• Fire watch ended:

  Date

Section 3: Authorisation of Permit

I declare that the above control measures are in place and communicated to the Competent Person in charge of the work

• Authorised Person:

  Sign

• Mobile Number:

• Valid From:

  Date

• Valid To:

  Date

Section 4: Acceptance of Permit by Competent Person in Charge

I acknowledge receipt of this permit and understand the safety precautions described above. I will adhere to the Method Statement and neither I, nor any person under my control will work on any other equipment. I will return this Permit to the Approved Person.

• Competent Person:

  Sign

• Mobile number:

Section 5: Time Extension (can only be granted by the Approved Person who issued the Permit)

• Authorised Person:

  Sign

• To:

  Date

Section 6: Completion of Works

I declare that the work detailed in section 1 has been completed or that no further work will take place until a new Permit is issued. The work area has been left safe, clean and tidy and equipment is safe to return to service unless otherwise stated.

• Competent Person:

  Sign

• Time/Date:

  Date

Section 7: Permit Closure

• Authorised Person:

  Sign

• Date/Time

  Date

Once the Permit has been closed, no further work activity can be undertaken and no return to high risk area is permitted.