Form · MHSWR regulation 3
RAMS template
Risk assessment and method statement for one activity: the sequence of work, a five by five risk matrix, PPE, permits, rescue, and a briefing record signed against the revision.
Free download · Editable PDF
Free permit to work template
A general permit to work for high-risk construction and maintenance work, as an editable PDF built on the essential elements in HSE guidance on permit systems. Three pages, from the job and its isolations to issue, shift handover, hand-back and cancellation.
- Format
- Editable PDF
- Pages
- 3
- Built on
- HSE HSG250
- Cost
- Free, always
What is in the permit to work template
3 pagesThe job
Permit number, location, the plant or equipment, the period the permit is valid for, and cross-references to other permits and isolation certificates.
Description and hazards
What is to be done and its limits, and the hazards, including those the work itself creates.
Isolations
Each isolation with its point, method and lock or tag, signed by the person who made it.
Precautions and checks
Precautions and emergency arrangements, atmosphere tests where they are needed, and protective equipment.
Issue and authorisation
The issuer confirms the precautions are in place, with a second signature for high-hazard work.
Acceptance to cancellation
The people working under the permit, shift handovers, hand-back when the work is done, and cancellation once the plant is back in service.
What HSE guidance says
Checked against the sourceWhat a permit is
A formal recorded process to control work identified as potentially hazardous, and a means of communication between management, supervisors and the people doing the work.
HSE HSG250, paragraph 9The essential elements
Thirteen of them, from the permit title and number to hand-back and cancellation. A permit that does not cover them is unlikely to be achieving its purpose.
HSG250, Figure 1 and paragraph 49Signatures
Dated and timed, and nobody should issue a permit to themself.
HSG250, paragraphs 26 and 49Shift handover
Work carried over to another shift needs a handover, and the incoming issuer should sign to continue the permit.
HSG250, paragraph 23Keeping permits
At site for at least 30 days after the work is complete, then archived.
HSG250, paragraph 58How to use it
Walk the job before issuing
The issuer checks the work site and the isolations in person. A permit issued from the office is a permit nobody checked.
Brief everyone under it
The person accepting the permit explains the work, the hazards and the precautions to everyone who will work under it, and they sign.
Hand it back, then cancel it
Work complete and the area safe first. Isolations come off only when every permit that shares them is signed off.
Asked most often
Questions about
Questions about
this template.
What is a permit to work?
A formal written system that authorises named people to do specific work, at a specific place, for a set period. The precautions are confirmed before the work starts and signed off when it ends.
When do you need a permit to work?
For work identified as potentially hazardous, where precautions must be in place and checked before anyone starts. Examples are work on isolated plant, in confined spaces, near live services, and hot work.
Who issues a permit to work, and who accepts it?
The issuing authority checks the site and signs that the precautions are in place. The performing authority accepts it for the people doing the work. Nobody should issue a permit to themself.
What happens to a permit at a shift change?
A handover confirms the plant is still safe to work on and the incoming people know the hazards. HSE recommends the incoming issuer signs to continue the permit.
How long should permits to work be kept?
HSE guidance says at site for at least 30 days after the work is complete, then archived so the system can be monitored and audited.
Is the permit to work template free and editable?
Yes. It is an editable PDF, free to download, use and reuse, including on paid work. Type into it in any PDF reader, or print it.
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Next step
The same records,
The same records,
without the paper.
On the platform these stop being sheets. The check, the person, the date, the signature and the action that followed are recorded as the work runs and retrieved by site.