The Permit To Work Form Template UK is available in different formats, including PDF, Word, and Google Docs, and offers editable and printable options for your convenience.
Permit To Work Form Template UK Editable – PrintableSample
Permit To Work Form Template UK 1. Permit Information 2. Location of Work 3. Description of Work 4. Work Activities 5. Risk Assessment 6. Required Safety Measures 7. Emergency Procedures 8. Personnel Involved 9. Sign-off and Approval 10. Supervisor Signature 11. Worker Acknowledgment 12. Date of Acknowledgment 13. Additional Observations
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Examples
[Site Name]
[Site Address]
[Site Manager’s Name]
[Site Manager’s Contact Number]
[Description of Work to Be Carried Out]
[Start Date]
[Start Time]
[Expected Duration]
[Name of the Permit Holder]
[Permit Holder’s Position]
[Permit Holder’s Contact Number]
[Date of Issue]
Please attach the risk assessment and provide a summary of the identified risks associated with the work.
[Summary of Risks and Mitigation Measures]
List of required safety measures to be implemented:
1. [Safety Measure 1]
2. [Safety Measure 2]
3. [Safety Measure 3]
This permit is authorized by:
[Name of Authorizing Person]
[Position]
[Signature]
[Date]
[End Date]
[End Time]
[Project Name]
[Location of Work]
[Project Manager’s Name]
[Project Manager’s Contact]
[Detailed Description of Work to Be Done]
[Scheduled Start Date]
[Scheduled Start Time]
[Duration of Work]
[Name of the Worker]
[Worker’s Job Title]
[Contact Information]
[Date Permit Issued]
Please outline all hazards related to the work:
1. [Hazard 1]
2. [Hazard 2]
3. [Hazard 3]
Outline the control measures that will be implemented to mitigate risks:
1. [Control Measure 1]
2. [Control Measure 2]
3. [Control Measure 3]
This permit has been reviewed and accepted by:
[Acceptance Name]
[Position of Accepting Person]
[Signature]
[Date]
This permit is valid until:
[Expiry Date]
[Expiry Time]
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