03 Permit To Work Form


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This template can be used to manage work permits. It captures all the details of the work to be carried out, the identified hazards, the PPE required and the safety procedures to be followed. It has a preconfigured Layout and you can add Workflow to notify the various interested parties or Logic as you require.

Contains: Layout   

List of styling customisations

  1. Uses a "header" section containing custom colours, font and icon with a title and description.
  2. The Approval sections contain an icon relating to the person who must provide the approval and some HTML containing the instructions.


 Code Used

  1. Contractor Declaration
    Signature confirming that the user undertaking the work is (1.) qualified to complete the work (2.) understands the hazards and the precautions listed to mitigate against them (3.) has been provided with or has access to the required PPE and (4.) undertakes to follow the safety procedures (5.) Undertakes that the information contained in this permit will be conveyed to all workers involved.
  2. In-House Authorization
    I have examined the work area detailed above and to the best of my knowledge all necessary precautions have been taken and the work can be carried out safely and without serious risk of injury to health. I give permission for the work to start.
  3. In-House Handback
    I confirm that the work has been completed in accordance with this permit. Services have been restored and the work area is ready for re-occupation. I confirm that all equipment has been returned to service, safety signs have been removed and the users informed that work may resume in this area.
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