Title Page
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Work Permit
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Tower Bridge
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Conducted on
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Prepared by
Work permit for general works
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Company name
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Work details - describe the work that is being carried out
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Location of the works being carried out
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Is there any PPE required? Contractors must supply and manage their own PPE
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Will anyone be affected by the works?
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Is there an impact on services or normal business?
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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
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Are works being carried out during normal operating hours?
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Are you suitably trained to carry out the works?
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Is your company aware of the works being carried out and your location?
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Do you have suitable emergency contact details?
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Are you lone working?
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Is it safe to work alone?
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Are your tools and equipment safe to use?
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Is the plant or equipment isolated and safe to work on?
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Is the work area safe?
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Are you and your team members aware of the evacuation process?
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Are there first aid facilities available
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Are there any hot works involved?
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Are you working at height?
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Are hazardous substances being used?
Permit authorisation
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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.
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Sign
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Permit authorised?
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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
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Sign
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Permit valid until? Add date
