Permit to Work - LV Electrical

• 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

• Is the equipment to be worked on isolated from all sources of supply? (check for dual feeds)

  Yes

  No

• Are safety locks & caution signs fixed at all points of isolation?

  Yes

  No

• Is the test equipment being used to prove dead of an approved type?

  Yes

  No

  N/A

• Has the equipment been proved dead and witnessed by the person carrying out the work?

  Yes

  No

  N/A

• Are conductors to be worked on earthed/primary earths secured with locks?

  Yes

  No

  N/A

• Where the work involves cable(s), has this been clearly identified?

  Yes

  No

  N/A

• Are danger signs fixed on all adjacent live equipment?

  Yes

  No

• Has one of the keys to the safety key box been given to the person carrying out the work?

  Yes

  No

• Method Statement/Switching Schedule, Isolation Drawing and Risk Assessment attached to Permit?

  Yes

  No

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

  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.

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.