Permit to Work

• Permit Number:

• Permit to Work prepared by:

• Date of Work:

  Date

• Company Name:

• On Site Personnel:

General Information:

• Site Induction complete?

  Yes

  No

• Company documentation received? RAMS / Risk Assessments / SSOWs / COSHH Data & Assessments / Training Certificates...

  Yes

  No

• Brief description of works:

• Have all necessary on site personnel been informed of the works taking place?

  Yes

  No

Working Area:

• Location of Works:

• Number of workers on site:

• If lone working, is monitoring required?

  Yes

  No

• Have any non-electrical services been isolated?

  Fire Alarm

  Water

  Gas

  Hazardous Chemicals

• Does the area need to be cordoned off?

  Yes

  No

Personal Protective Equipment:

• Is there any requirement for PPE?

  Yes

  No

• Does the worker have all required PPE to complete the works?

  Yes

  No

• Safety Glasses / Goggles / Visor

• Gloves

• Safety Footwear

• Hearing Protection

• Bump Cap / Hard Hat

• Dust Mask

• High Visibility Clothing

• Other:

• State additional PPE requirements:

Work Permits - Are any of the following work permits required?

• Hot Works

  Yes

  N/A

• At least 2 Fire Extinguishers available?

  Yes

  No

• Barricades, warning, signs, & spark / flash screens in place?

  Yes

  No

• Work area clear of flammable liquids, gases, or vapours?

  Yes

  No

• Have combustibles located within 15m of the working area been removed, or protected with non combustible curtains, metal guards, or flame proof covers?

  Yes

  No

• The work area and all adjacent areas have been inspected at the completion of works ensuring no fire conditions were present.

  Yes

  No

• There are provisions for the hot work area and any adjoining areas to be patrolled from the start of the work until 60 minutes after the work is completed.

  Yes

  No

• Has the work area been cleaned and clear to prevent any trip or slip hazards?

  Yes

  No

• Fire Sprinklers and / or thermal detectors must be confirmed operational where installed.

  Yes

  No

• Have smoke detectors been isolated in the work area? De-Isolate within 40 minutes of works completion.

  Yes

  No

• The work area and all adjacent areas where sparks may spread were inspected after works complete, ensuring no fire conditions were present

  Yes

  No

• Electrical Isolation:

  Yes

  N/A

• State machinery / plant to be isolated:

• Method of Isolation:

  Yes

  No

• State isolation points:

• Has approval been given for the isolation?

  Yes

  No

• Testing equipment is in good working order?

  Yes

  No

• Locks and/or tags have been installed?

  Yes

  No

• Confined space

  Yes

  N/A

• Has the worker completed confined space training?

  Yes

  No

• Lifebelt and rope in place for confined space working?

  Yes

  No

• Working at heights

  Yes

  N/A

• Has the worker provided evidence of Working at Heights training?

  Yes

  No

• Are scaffolding or ladders required?

  Yes

  No

• Scaffolding have been checked prior to use?

  Yes

  No

• Ladders have been checked before use? To be tied / footed.

  Yes

  No

• Is fall restraint system required?

  Yes

  No

• Has the worker provided evidence of training in the use of fall restraint equipment?

  Yes

  No

• Fall restraint equipment is in good working order and in date?

  Yes

  No

Completion of Work:

• Has the work area been restored to normal safety / housekeeping requirements?

  Yes

  No

• Have all isolations and alarms been reactivated?

  Yes

  No

• Fire watch completed if job involved Hot Works?

  Yes

  No

• Barwell Global Signature:

  Sign

• Lead Contractor Signature:

  Sign