Title Page

  • Work Permit

  • Tower Bridge

  • Conducted on

  • 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

  • Is there any PPE required? Contractors must supply and manage their own PPE

  • Will anyone be affected by the works?

  • Is there an impact on services or normal business?

  • Is there a suitable risk assessment associated with the works?

If the answer is no then a suitable risk assessment should be obtained prior to the works starting

Contractor questions

  • Are works being carried out during normal operating hours?

  • Are you suitably trained to carry out the works?

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

  • Do you have suitable emergency contact details?

  • Are you lone working?

  • Is it safe to work alone?

  • Are your tools and equipment safe to use?

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

  • Is the work area safe?

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

  • Are there first aid facilities available

  • Are there any hot works involved?

  • Are you working at height?

  • Are hazardous substances being used?

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

  • Permit authorised?

  • Person authorising the work: This permit is authorised on the understanding that all risks will be suitably managed at all times.

Person authorising the works: This permit

  • Sign

  • Permit valid until? Add date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.