Third Space Work Permit

• Work Permit

• Canary Wharf

• Conducted on

  Date

• Prepared by

Work permit for general works

• Company name

• Work details - describe the work that is being carried out

• Location of the works being carried out

• Are you undertaking hot works?

  Yes - complete hot works permit

  No

  N/A

• Have any impacts on normal operations been explained and agreed to?

  Yes - proceed

  No - seek authorisation

  N/A - proceed

• Has permission been given to carry out the works?

  Yes

  No - obtain permission

• Are the works covered by a suitable risk assessment?

  Yes

  No

  N/A

Contractor questions

• Are works being carried out during normal operating hours?

  Yes

  No - give details

• Is your company aware of the works being carried out and your location?

  Yes

  N/A

• Are your tools and equipment safe to use?

  Yes

  N/A

• Is the plant or equipment isolated and safe to work on?

  Yes

  N/A

• Is the work area safe?

  Yes

  N/A

• Has the contractor been informed of site specific processes such as restricted areas - lights being turned on/off - lifts usage - out of hours restrictions?

  Yes

  N/A

• Are you and your team members aware of the evacuation process?

  Yes

  No - do not proceed

Permit authorisation

• Number working in team

Person in charge of the works: I confirm that I have verified the details on this form to be correct and will ensure that all necessary precautions have been taken. The work will be undertaken and managed in a safe manner ensuring that all hazards and risks are suitably controlled at all times.

• Sign

  Sign

Person authorising the works: This permit

• Sign

  Sign

• Permit end date and time

  Date

• Permit start date and time

  Date