Permit To Work Form

Keep your workplace safe and compliant with our Permit to Work Form. Designed for site managers, supervisors, contractors, and HSE officers, this template provides a structured, repeatable way to authorise, monitor, and close high-risk tasks.

Using a permit to work ensures that risks are identified, controls are applied, and work is performed safely, while maintaining records for compliance, audits, and continuous improvement. This form guides users through all critical stages so nothing important is missed.

What is included

Permit Title Page:

• Permit issue date and number
• Site/facility and department/area
• Description of work and exact work location
• Permit holder (person in charge) and authorising supervisor
• Company/contractor and contact details

Permit Timing:

• Planned and actual start/finish dates and times
• Record keeping for accurate timing and scheduling

Hazards & Controls:

• Task steps and hazard descriptions
• Likelihood/risk level assessment
• Required control measures and implementation verification
• General control checklist (work area isolation, PPE, lockout/tagout, emergency arrangements)
• Notes and additional information

Authorisations:

• Permit issuance (issuer name, position, signature, date and time)
• Permit acceptance (permit holder name, signature, acceptance date and comments)
• Permit suspension, extension, or cancellation tracking with authorisation

Permit Closure:

• Verification that work is completed as per permit
• Work area inspected and safe
• Personnel and equipment removed
• Completion comments and signatures from permit holder and supervisor

Using this template allows you to:

• Standardise permit-to-work processes across teams and sites
• Identify hazards and enforce controls before work begins
• Track authorisations and compliance through every stage of the task
• Maintain clear records for audits, inspections, and regulatory compliance
• Ensure safe completion and handover of high-risk work areas

Disclaimer: This template is provided as a guidance tool only. All permits must be issued, managed, and closed in accordance with your organisation’s procedures and local health and safety regulations. We do not accept responsibility for how this form is used.

Download the Permit to Work Form today to streamline high-risk work authorisation, strengthen safety compliance, and protect your workforce.