Permit to work
Type of work
Tick all that apply. Hot work and confined space entry have their own permits. Attach them to this one.
- Hot work
- Confined space entry
- Work on isolated or energized equipment
- Work at height
- Excavation or digging
- Lifting with a crane or hoist
- Breaking into a line or vessel
- Other (write in)
Hazards
What could hurt someone on this job, including other work nearby.
Isolations
Each energy source or line, where it's isolated, the lock or tag, and who verified zero energy.
Precautions in place
- Job safety analysis or pre-task plan done
- Area barricaded and signed
- Atmosphere tested, if required
- Fire watch or fire extinguisher, if required
- PPE below is worn
- Rescue and emergency plan in place
- Crew briefed on this permit
- Other crews nearby know about this job
PPE and equipment
Issue and acceptance
The issuer signs that the area and the controls were checked at the job. The person in charge signs that they understand the permit and the crew has been briefed.
Shift handover
If the work runs past one shift, the permit is handed over in person, at the job.
Closeout
The work is finished or stopped, the area is left safe, isolations come off only when it's safe, and the issuer closes the permit.
Sign-on