Templates
Permit to work template

Permit to work template

Use this permit to work template to ensure that important safety checks and emergency procedures are followed before hazardous work begins. Share it with your team and contractors.

Use this template
or download pdf
Permit to work template

Use this permit to work template to ensure that important safety checks and emergency procedures are followed before hazardous work begins. Share it with your team and contractors.

Use this template
or download pdf

About the Permit to work template

High-risk work can pose serious threats to worker safety and business operations. To manage it properly, you need an organized permit to work template. This allows you to standardize how work is initiated and authorized so your team follows the necessary safety protocols.

Whether you’re in construction, manufacturing, or any field with complex risk factors, this template helps you stay compliant and minimizes operational risks. Use it to formalize work requests, document safety checks, and grant formal approvals with confidence.

Benefits of using the permit to work template

A permit to work template is an essential tool for ensuring that high-risk tasks are conducted safely and efficiently. With this template, you can create a clear process for approving and overseeing potentially hazardous activities. Your team can focus on the task at hand without missing critical safety steps, plus you can keep track of key details, from safety checks to team assignments.

The template also guides you in clearly documenting the approval process, with safety protocols communicated effectively across teams. It minimizes confusion and reduces the risk of accidents, leading to a safer work environment.

Since the template is customizable, you can also adapt it to keep your operations compliant with regulations, while keeping tasks moving forward smoothly.

How to use the permit to work template

Here’s a simple step-by-step guide for incorporate the template into your workflow:

  1. Create and assign the permit. Start by filling out key information, such as the work activity title, start and end dates, and high-risk tasks involved. Assign the permit to the responsible supervisor who will oversee the task.
  2. Complete the risk assessment. Before any work begins, make sure that the risk assessment and control forms are filled out thoroughly. These documents are critical to identifying hazards and outlining the necessary safety controls.
  3. Communicate safety protocols. Use the template to inform all team members of the safety requirements and control measures that must be followed. All frontline staff should understand their role in maintaining safety standards.
  4. Authorize the work. The permit must be approved by an authorized person, confirming that all risks have been assessed and the necessary precautions are in place. This step formalizes the work, so the team can proceed confidently.
  5. Monitor and track progress. Throughout the task, the template helps you track progress, monitor hazards, and confirm all safety protocols are being followed. By keeping detailed records, you can maintain a safe and controlled work environment.

Download Lumiform’s permit to work template today

Take control of high-risk tasks and improve safety with our permit to work template. This template allows you to efficiently organize work approvals, track progress, and manage risk assessments, giving your team the structure they need to work safely and confidently. Use it now to streamline task management while staying compliant with industry regulations.

Categories

  • Risk management and compliance templates
  • General templates
  • Risk assessment templates
Preview of the template
Permit Request
Work Activity Title
Specified high-risk work tasks covered to work by this permit
Start of Work
End of Work
Permit Request (On-site supervisor of the contractor/workers who have been engaged to perform the work)
This acknowledgement signifies a formal request to commence a work activity invoking one or more specified high-risk tasks. As the person requesting this permit, I hereby certify that
I have developed and/or reviewed the Risk Assessment and required Control Form/s relevant to this work activity.
I have consulted with relevant people to ensure that controls are adequate.
I am competent to coordinate this work activity in accordance with the attached Risk Assessment and Control Form/s.
I shall undertake to implement all planned and necessary controls to ensure the health and safety of those completing or impacted by the activity.
I shall ensure that the persons required to carry out the work are advised of and understand the requirements of the Risk Assessment and Control Form/s, and the Permit To Work / Access Instructions in Section 4 below.
I shall monitor hazards and control methods throughout the work activity.
I am requesting this Permit to be reviewed, registered and numbered by the Permit to Work Authorised Person.
Completion
Full Name and Signature of Supervisor
Person Engaging Contractor/Worker Review
Person Engaging Contractor/Worker Review
This sign off is to signify that the PBPL person who engaged the contractor/worker has reviewed all documentation and provided comments
I have reviewed the content of all related documents including the Risk Assessment and required Control Form/s and provided feedback to the contractor/workers.
I confirm as the person who engaged the contractor/worker, I will monitor the methods of work and the implementation of the proposed controls to ensure that standards for health and safety are being achieved throughout the works.
I have informed the relevant person/s for the area that the work is being performed in, the full scope of works to be completed by the contractor/workers and the processes developed for supervising and enforcing the works.
Completion
Full Name and Signature of Person Engaging Contractor/Worker
Authorization
Authorization
This authorization signifes that the planning component of the work activity has been completed and that the work is authorized to commence in accordance with the risk assessment and required control forms. As the Permit to Work Authorized , i hereby certify:
I have reviewed the content of all related documents including the Risk Assessment and required Control Form/s.
I have registered this permit in the Permit To Work Register, allocated it a number and have written the number on all associated documents.
Complete
Full Name and Signature of Permit to Work Authorized Person
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Frequently asked questions

What are the key components of an effective permit to work system?

An effective permit to work system includes clear descriptions of tasks and risk assessments. It should also have a formal authorization process that requires sign-off from designated approvers, such as supervisors or safety managers. On top of this, it includes detailed communication plans and emergency procedures.

What’s the difference between hot and cold work permits?

Hot work permits involve tasks that generate heat or sparks, like welding or cutting, and require strict fire safety measures. Cold work permits cover non-heat generating tasks, such as electrical maintenance or confined space entry. By understanding these differences, you can apply the right safety precautions for each type of work.

What are some common mistakes to avoid when filling out a permit to work?

Avoid vague descriptions of tasks and incomplete risk assessments. Always double-check that all sections are filled out accurately, and that the necessary authorizations are obtained. Forgetting to review safety measures or skipping training updates can also lead to oversights.

How should I proceed if my permit to work is rejected?

First, review the feedback carefully to understand the reasons for rejection. Address any missing information or compliance issues, and consult with a supervisor if needed. You can use this as an opportunity to improve your understanding of the process. Afterwards, reapply with the corrected details to avoid further delays.

If there’s no valid permit to work, what are the consequences?

Operating without a valid permit can lead to severe safety risks, legal penalties, and potential shutdowns. It may also result in accidents or injuries because of unassessed hazards. Always prioritize obtaining and maintaining valid permits to protect both personnel and the organization from unnecessary risks.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.