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    All templatesPermits · 3 pages · Updated 20 October 2026

    Permit to Work Template

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    Three-page general permit to work for one job: description of the work and its location, validity, the other permits the job needs, hazards and precautions, isolations by reference, fire precautions, a tests record, issue and acceptance, the people working under the permit, the issuer's site checks, shift handover, suspension, hand-back and cancellation. It is not a hot work, confined space or electrical permit, and not a safety device bypass record: where the job involves one of those, that permit is issued as well. General information, not legal advice.

    What's inside

    Page 1: the job, the hazards and the isolations

    1. Permit and job: permit number, date and time issued, the work order or task risk assessment reference, job location and plant identification, a description of the work and its limits (what is not covered), who requested it, the company or crew and how many people
    2. Validity: valid from and to (date, time), and whether the permit runs longer than one shift
    3. Other permits this job needs: tick hot work, confined space entry, electrical work or high voltage isolation, work at height, excavation, breaking containment or other, and the numbers of the other permits and isolation certificates this permit refers to
    4. Hazards and precautions: hazards including residual ones and those the work creates, precautions and who took them (name or initials, time), the action in an emergency, and protective equipment
    5. Isolations (reference only): mechanical, electrical, process or other, the isolation certificate or lock record numbers, the isolation points, and whether the isolations were verified, by whom and when

    Page 2: fire precautions, tests, rescue and sign-off

    1. Fire precautions (if the job could start a fire): fire risk assessment complete, combustibles cleared or protected, fire watch designated, extinguisher type and position, post-work fire watch and the time finished
    2. Tests and monitoring record: limits for this job, then time, oxygen, flammable gas (LEL), hydrogen sulfide, carbon monoxide, other and tester, and whether monitoring is continuous
    3. Emergency and rescue arrangements: rescue plan in place, who to call and how, rescue or emergency equipment and how the workers keep in contact
    4. Issue and acceptance: issuer, permit authoriser (for high-hazard work), receiver, fire watch and attendant, with name, signature, date and time

    Page 3: the people, handover, suspension and cancellation

    1. People working under this permit: name, company, signature that the permit was read and understood, times on and off site
    2. Issuer's site checks: date and time, who checked, and whether the conditions of the permit were being followed
    3. Shift handover or extension: outgoing and incoming receiver, the incoming issuer's confirmation that the plant is still safe and the hazards were explained, and the new expiry
    4. Suspension: suspension and cancellation criteria (any change in readings, loss of communication, equipment failure or alarm, reissue required), suspended at, reason, the state the plant was left in, and the restart after revalidation or a new permit
    5. Hand-back and cancellation: work complete, plant safe and isolations removed or cross-referred, area handed back, tested and recommissioned, copies collected, with receiver, issuer and closeout signatures

    This is a general permit for one job. It is not a hot work, confined space or electrical permit. The section titles and tick options are ours, to change.

    What requires or shapes this record

    No source opened for this page says that every job needs a permit or supplies one form that fits all work. HSE's guidance says permit-to-work systems should be considered for work that may adversely affect people, plant or the environment but should not be applied to all activities, and that following the guidance is not compulsory. This form is a general permit and does not replace the specialist permits the same guidance mentions: separate forms may be needed for hot work and confined space entry, and an electrical permit is a statement that equipment is safe to work on that should not be issued on live equipment. In the US, the confined space standard sets what an entry permit must show and the welding and cutting standard asks the person authorising the work to designate precautions, preferably in a written permit; both cover specific kinds of work, not a general job. In Great Britain, HSE's guidance lists legislation relevant to permits-to-work, and regulation 5 of the Confined Spaces Regulations 1997 (legislation.gov.uk) says nobody may enter or work in a confined space without suitable and sufficient rescue arrangements. CCOHS in Canada describes entry permits for confined spaces and a hot work permit as one step in a hot work program. Which rules apply depends on your country, your industry and the job. A completed form does not show compliance with any law or standard. This page is general information, not legal advice.

    • HSE, HSG250 Guidance on permit-to-work systems (first edition 2005, free web version), paragraphs 5, 9 to 26, 47 to 49 and 58, Figure 1 and Appendix 2

      HSE guidance for Great Britain, written for the petroleum, chemical and allied industries and useful to others that use permits; the guidance says following it is not compulsory. A permit-to-work system is a formal recorded process for controlling work identified as potentially hazardous and a means of communication between management, supervisors, operators and those doing the work (paragraph 9); issuing a permit does not by itself make a job safe (paragraph 5). Systems should be considered where work may affect people, plant or the environment but not applied to every activity, and are normally most appropriate to non-routine work, work needing co-ordination between groups and work passing from one group to another (paragraphs 14 and 15). Paragraph 17 lists jobs for which additional permits or certificates should be considered, among them heat or sparks, high voltage or other electrical work that may give rise to danger, entry into tanks and confined spaces, and work at height; paragraph 48 says separate forms may be needed, for example for hot work and confined space entry. Appendix 2 says an electrical permit is primarily a statement that a circuit or item of equipment is safe to work on and should not be issued on equipment that is live. Figure 1 lists thirteen essential elements of a permit form: title; reference number with reference to other permits or isolation certificates; job location; plant identification; description of the work and its limitations; hazards including residual ones; precautions and actions in an emergency, signed by those who took them; protective equipment; issue; acceptance; extension or shift handover with a new expiry time; hand-back; and cancellation. Paragraph 49 asks for signatures to be dated and timed. Other paragraphs: copies displayed at the work site and in the control room (18); a suspended permit stays live until it is cancelled, so isolations may remain, and work restarts only after the issuing authority has revalidated it or issued a new one (19 and 20); interaction between permits (22); shift handover, with the incoming issuing authority signing to allow continuation (23); hand-back questions (24); site visits by the issuing authority at least at start and completion (25); a second person to see the permit for particularly high-hazard work, and nobody issuing a permit to themselves (26); and permits kept at site for at least 30 days after completion, then archived (58). Paragraph 47 advises text no smaller than 8 point. Appendix 1 lists legislation relevant to permits-to-work, including the Confined Spaces Regulations 1997 and the Electricity at Work Regulations 1989. The web version is the 2005 first edition and is written for industries that use large permit systems, so adapt it to your own scale.

    • 29 CFR 1910.146(b), (d)(5), (e) and (f), Permit-required confined spaces (US OSHA; text read through the eCFR, current to 16 October 2026)

      A US rule for general industry (it does not apply to agriculture, construction or shipyard employment), and only for permit-required confined spaces. Where it applies, the employer prepares a written entry permit before entry; the entry supervisor signs it to authorise entry; it is posted at the entry portal or made available by an equally effective means so entrants can confirm the preparations are done; its duration may not exceed the time the task needs; the supervisor ends entry and cancels it when the work is complete or a condition not allowed under the permit arises; and each cancelled permit is kept for at least 1 year ((e)). Paragraph (f) lists fifteen things the permit must identify, among them the space, the purpose, the date and duration, entrants, attendants and entry supervisor, the hazards, the measures used to isolate the space and control its hazards (the note mentions lockout or tagging), acceptable entry conditions, the results of initial and periodic tests with the testers' names or initials and when each was done, the rescue and emergency services and the means of summoning them, the communication procedures, the equipment, and any other permits, such as for hot work, issued for work in the space. Atmospheric tests are done in the order oxygen, then combustible gases and vapours, then toxic gases and vapours ((d)(5)(iii)). The definition of a hazardous atmosphere includes flammable gas above 10 percent of its lower flammable limit and oxygen below 19.5 or above 23.5 percent. Those figures belong to that rule and to permit spaces, so this form prints no gas limits: it leaves them for the issuer or the specialist permit to set. The standard's own text is not reproduced here.

    • 29 CFR 1910.252(a)(2), Welding, cutting and brazing, fire prevention (US OSHA), and 29 CFR 1910.147(c)(1), (f)(2) and (f)(4), Control of hazardous energy (eCFR, current to 16 October 2026)

      Two US general industry rules. Section 1910.252(a)(2) says fire watchers are required when welding or cutting is done where more than a minor fire might develop or where listed conditions exist, such as appreciable combustible material closer than 35 feet (10.7 m) to the point of operation. Fire watchers must have extinguishing equipment readily available, be trained to use it and know how to sound an alarm, and the watch is kept for at least half an hour after the welding or cutting ends. Before cutting or welding is permitted, the area is inspected by the individual responsible for authorising it, who designates the precautions, preferably in a written permit. Where practicable, combustibles are moved at least 35 feet from the work site, and otherwise protected. Section 6 of the form carries those checks over, with the 35 feet and the 30 minutes printed as what that US rule says, not as general limits. Section 1910.147 covers servicing and maintenance of machines and equipment where unexpected energisation, start-up or release of stored energy could injure employees (construction and agriculture are excluded). The employer's energy control program is to isolate the equipment from the energy source and render it inoperative before servicing ((c)(1)); the on-site and outside employer inform each other of their lockout or tagout procedures ((f)(2)(i)); and specific procedures are used at shift or personnel changes to keep lockout or tagout protection continuous ((f)(4)). The word permit does not appear in that standard, so the form only refers to the isolation record in section 5 and has a handover in section 12.

    • CCOHS, OSH Answers: Confined Space - Program (fact sheet revised 8 November 2022) and Welding - Hot Work (revised 12 August 2024)

      Canadian guidance from the Canadian Centre for Occupational Health and Safety. No general permit-to-work page was found, so the two pages that deal with permits are used. The confined space page calls an entry permit an administrative tool that documents the completed hazard and risk assessment for each entry, and says one is required where the controls (atmospheric monitoring, isolation, lockout, ventilation, safeguarding devices, respiratory protection or others) need to be verified and documented; some jurisdictions require a permit for every entry. It lists what a permit should contain at least, including how long it is valid, the workers authorised to enter, the attendant and the supervisor, the location, scope and hazards, the atmospheric testing details with the last calibration date, control measures, communication, the emergency plan and equipment, and signatures of the tester and the supervisor; the permit is posted at the space until the work is complete, a copy is kept on file, and the exit time is noted. The hot work page (https://www.ccohs.ca/oshanswers/safety_haz/welding/hotwork.html) says getting a hot work permit is one step in a hot work management program that sets where and when hot work is allowed, who authorises, performs and monitors it, and how to obtain a permit. Both pages are about those two kinds of permit, not about a general one.

    Each source checked on 20 October 2026. Not legal advice; check the text in force for your site.

    Field by field

    The form is for one job, from the request to the cancellation. The section titles and tick options are ours: change them to fit your site and keep them the same from permit to permit. The fire precautions and the tests record are for jobs that need them; they sit beside, and never in place of, a hot work or confined space entry permit where one is required. The form prints no gas limits, no maximum duration and no number of signatures: your own procedure sets them. The two figures it does print, 35 feet and 30 minutes, are labelled as the US welding and cutting rule's.

    Permit number
    Why: The identifier every other record cites: the isolation certificate, the test record and any specialist permit. HSG250 Figure 1 asks for a reference number, and the copy displayed at the job must match the one on file.
    Common mistake: Leaving it blank on the displayed copy, or reusing a number, so the copy at the job cannot be matched to the permit on file.
    Job location and plant identification
    Why: HSG250 Figure 1 lists the job location and the plant identification as separate elements: the first says where, the second says which item.
    Common mistake: "Pump bay" when the bay holds four pumps. Write the tag or equipment number.
    Description of work to be done, and its limits
    Why: HSG250 paragraph 12 says the permit should make clear the exact identity, nature and extent of the job and any limits on its extent and time. Writing what is not covered means work outside it has to be asked for separately.
    Common mistake: "General maintenance in the area", or letting the job grow under the same permit as it goes.
    Valid from and to
    Why: HSG250 paragraph 11 describes a permit as authorising certain people to do specific work at a specific site at a certain time. The US confined space rule adds that an entry permit may not last longer than the task needs.
    Common mistake: A validity longer than the shift with no handover signature (HSG250 paragraph 23), or a permit left open until the job is finished.
    Other permits this job needs
    Why: HSG250 paragraph 48 says separate forms may be needed for hot work and confined space entry, and Figure 1 asks for references to other permits and isolation certificates. This permit does not replace them: tick each, issue it first and write its number here. The US confined space rule also asks the entry permit to name any other permit, such as hot work.
    Common mistake: Starting under this permit and finding the specialist permit was never issued, or two permits for one job that do not name each other.
    Hazards, including residual ones
    Why: Figure 1 asks for hazards including residual ones and those the work creates. Residual hazards are what remains after the precautions, such as pressure left between two closed valves. HSG250 paragraph 22 adds that one job can create danger for another.
    Common mistake: Listing the hazard of the plant but not the hazards the work itself creates, or those of work going on nearby.
    Precautions needed and who took them
    Why: Figure 1 asks for the precautions and the actions in an emergency, signed by the people who carried the precautions out. Here each row has the name or initials and the time.
    Common mistake: A list nobody signed, or precautions marked as taken that are not in place when the permit is issued, other than those that can only be taken during the work.
    Isolations verified
    Why: HSG250 paragraph 22 says isolations should be clearly detailed on the permit or on a cross-referenced isolation certificate. The US lockout standard (1910.147) sets the energy control program; this form refers to that record and does not replace it.
    Common mistake: A tick instead of numbers. Write the isolation certificate or lock record number, the points and who verified them.
    Fire precautions
    Why: Carried over for jobs that could start a fire. The US welding and cutting rule requires fire watchers in some cases, with extinguishing equipment at hand and a watch kept for at least half an hour after the work, and says combustibles are moved at least 35 feet away where practicable. Where a hot work permit is required, that permit governs.
    Common mistake: Ending the watch when the work stops. The time finished is what shows the post-work watch was kept.
    Tests and monitoring record
    Why: Where a job needs tests, the record shows who tested, when and what. The US confined space rule asks for test results with the tester's name or initials and the time, and says to test oxygen first, then combustible gases, then toxic ones. The limits are left blank for the issuer or the specialist permit to set.
    Common mistake: One reading at the start and none later, or limits copied from another site's form instead of set for this job.
    Rescue plan in place
    Why: The US confined space rule asks for the rescue and emergency services and how to summon them, CCOHS lists an emergency plan and equipment, and regulation 5 of the Confined Spaces Regulations 1997 (Great Britain) says nobody may enter or work in a confined space without suitable rescue arrangements. For other jobs the same question applies in a lighter form: who is called, and how.
    Common mistake: A tick with no phone number, radio channel or equipment named.
    Issue and acceptance
    Why: Figure 1 asks for the issuer's signature that isolations are made and precautions taken, except those that can only be taken during the work, and the receiver's signature that the work, hazards and precautions are understood. HSG250 paragraph 26 asks for a second person for particularly high-hazard work and says nobody issues a permit to themselves; paragraph 49 asks for dated and timed signatures.
    Common mistake: The same person as issuer and receiver, or a signature with no time.
    People working under this permit
    Why: Figure 1's acceptance element includes that the permit information has been explained to all permit users. The roster shows who they are and when each was on site; the US confined space rule asks the permit to identify entrants by name or by a roster.
    Common mistake: A roster not updated when people swap in, or one signature by the supervisor for the whole crew.
    Issuer's site checks
    Why: HSG250 paragraph 25 asks for site visits by the issuing authority to check the conditions of the permit are being met, at least at the start and at completion, with interim checks depending on the hazard, complexity and duration.
    Common mistake: Issuing from the office and never seeing the site. HSG250 paragraph 51 says permits should not be issued remotely without a site visit.
    Shift handover or extension
    Why: Figure 1 asks for signatures confirming the plant remains safe, new people made aware of the hazards and a new expiry time; paragraph 23 recommends the incoming issuing authority signs to allow the permit to continue. The US lockout standard asks for specific procedures at shift or personnel changes to keep isolation protection continuous.
    Common mistake: A verbal handover, or an extension with no new expiry written down.
    Suspension
    Why: HSG250 paragraphs 19 to 21: work may be suspended, the plant condition is recorded, and work restarts only after the issuing authority has revalidated the permit or issued a new one. The form's rule is reissue after any change in readings, loss of communication, equipment failure or alarm activation.
    Common mistake: Treating a suspended permit as dead. HSG250 paragraph 19: it stays live until cancelled, and isolations may still be in place.
    Hand-back and cancellation
    Why: Figure 1 asks for hand-back signed by the performer and issuer and a cancellation certifying the work tested and the plant recommissioned; paragraph 24 lists the questions. The US confined space rule cancels an entry permit when the work is complete or a prohibited condition arises, and keeps it for at least a year; HSG250 paragraph 58 keeps permits at site for at least 30 days after completion, then archived for a period the site sets.
    Common mistake: Cancelling when the performer leaves, before anyone checks the plant. HSG250 case study 5: one fitter returned the permit while the other was still working on the open pipe, and steam was turned on.

    Worked example

    IllustrativeA general permit, filled (invented site, people and numbers)

    SectionEntry
    1 Permit and jobPTW-0231, issued 12 May at 07:40. Area 2, pump bay, transfer pump P-14. Replace the mechanical seal. Limits: the pump only; no work on the discharge line beyond valve V-142; the overhead crane is not to be used. Requested by the maintenance planner; a crew of two from the maintenance team.
    2 and 3 Validity and other permitsValid 07:40 to 15:30 on 12 May, which is 7 h 50 min and inside one shift. No hot work, confined space or electrical permit is needed. The permit refers to isolation certificate IC-0415.
    4 Hazards and precautionsResidual product in the casing: drained to the sump and checked. Pressure trapped between V-141 and V-142: vented through the bleed valve. Hot casing: left to cool and touch-tested. Product on the floor: absorbent mat. Chemical gloves and goggles. In an emergency: stop, use the eyewash 6 m from the pump, call the control room on radio channel 2.
    5 IsolationsV-141 and V-142 closed and locked, bleed open. P-14 locked off at the motor control centre and the start button tried. Certificate IC-0415, verified by the issuer at 07:35.
    6 and 7 Fire precautions and testsNot a hot work job, so section 6 is not used. Flammable gas reading of 0% LEL at 07:50 before the casing was opened, and again at 11:55 after the restart (tester initials RH).
    9 and 10 Issue, acceptance and peopleIssuer: the shift supervisor. Receiver: the senior fitter. No permit authoriser, because the job was not rated high hazard. Both signed at 07:40 and the second fitter signed in section 10.
    13 SuspensionA plant general alarm sounded at 11:10. Work stopped and the permit was suspended with the pump in pieces and the isolations still on. The issuer checked the area and revalidated the permit at 11:50; work restarted at 11:55. That is 45 minutes suspended.
    14 Hand-back and cancellationThe receiver certified the work complete at 14:20. The issuer confirmed the pump was ready for testing at 14:25. The locks were removed at 14:30 by those who applied them, operations acknowledged the return of the pump at 14:35, and the permit was cancelled at 14:45 after the pump was run and tested. PTW-0231 was filed with IC-0415.

    From issue at 07:40 to the hand-back at 14:20 is 6 h 40 min; less the 45-minute suspension, the crew worked for 5 h 55 min, inside the validity that ran to 15:30. The job, names, times and valves are invented to show how the form is used, and are not recommendations: your own procedure sets who may issue a permit, how long it may last and what must be checked.

    When a spreadsheet stops being enough

    A paper permit in a binder works for a site with few permits and one issuer. It stops working when an issuer must see every live and suspended permit, and the isolations they share, before issuing another (HSG250 paragraphs 19 and 22), when permits run over several shifts and each handover must be signed, and when records must be found again: HSG250 paragraph 58 keeps them at site for at least 30 days, then archived.

    HSG250 paragraph 51 lists what an electronic permit system must provide before it replaces paper: password-protected electronic signatures to prevent unauthorised issue or acceptance, no remote issue without a site visit, no alteration of an issued permit without telling everyone concerned, paper copies for display at the job, training so operators do not copy sections from other permits, and a back-up for software failure or power loss. Those are the questions to put to any vendor.

    Whatever you choose, test it with one of your own permits: issue it, suspend it, hand it over to another shift, and cancel it, including at a work face where the connection is lost.

    Same rule for every product: tagged “Permit to Work”, “Permits to Work (PTW)” or “Control of Work”, with a sourced permit-to-work or isolation capability in its record, or one the vendor stated to us, labelled as vendor-stated. Documented and conditional capabilities qualify; check the linked scope before treating a module as included.

    Tekmon pays for a sponsored placement (above); its place in this list follows the same rule as every entry. How lists are ordered

    All 21 matching profiles are shown. Documentation review, not hands-on testing or a claim of compliance.

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