Template

ESSW SMS 941 - MSSW Limitation of Access Permit

by Melvin keyani, from the Community

This Limitation of Access Permit template (ESSW SMS 941 – MSSW) helps control entry to restricted work areas and authorize tasks safely. It captures permit holder details, risk assessments, and method statements; lists typical hazards such as working at height, manual handling, mechanical and electrical risks; and records approvals by an Authorised Person. Sections cover authorization to commence, receipt, clearance, cancellation, key control, and responsibilities to secure and tidy the area.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

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This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
ESSW SMS 909: Limitation of Access Permit
Use this Limitation of Access Permit (ESSW SMS 909) to control entry to restricted areas and authorize specific work. The form captures permit holder details, competency checks, and hazards such as electrical, mechanical, manual handling, slips and trips, and work at height. It supports key issuance, isolation verification, and mandates on-site display and lock-and-tag procedures. Sections include authorization to commence, receipt, clearance, and cancellation to ensure the area is secured, left safe, and keys are returned.
by Melvin keyani, from the Community
Downloads: 10+
Get
Template
ESSW SMS 909 - Limitation of Access Permit
This Limitation of Access Permit template (ESSW SMS 909) helps control entry to restricted areas and ensure safe, authorized work. It guides permit holders and authorized persons through competency checks, risk assessment and method statement confirmation, identification of hazards such as electrical, mechanical, work at height, slips and trips, and coordination with other trades. The template covers authorization to commence, additional persons, keys issued, signatures, receipt, clearance, and cancellation, plus responsibilities for securing areas and returning keys. Use it to formalize isolation, communication, and safe access procedures on site.
by Melvin keyani, from the Community
Downloads: 10+
Get
Template
RNM Limitation of Access Permit
This RNM Limitation of Access Permit template helps you manage work in restricted areas and ensure site safety. It guides permit holders and authorized persons through permit details, risk assessments, and competency checks before work begins. Record hazards such as work at height, manual handling, electrical and mechanical risks, and working around other trades. Document issued keys, additional personnel, and the description of works. Capture signatures for authorization, receipt, clearance, and cancellation, including photo evidence that the area is secure. The template reinforces responsibilities for controlling access, locking restricted areas, communicating with other permit holders, and returning keys to the site permit office on completion.
by Peter Bain, from the Community
Downloads: 10+
Get
Template
ESSW SMS 904 Permit to Work
Use this ESSW SMS 904 Permit to Work template to formalize authorization and control of high risk activities on site. Record permit holder details, risk assessment confirmation, location and scope of work, isolation and earthing points, safety locks and caution notices, and keys issued. Capture signatures from the responsible person and the authorised person to start, suspend, or cancel work, and document clearance at shift end. This form helps enforce restricted area access, tool and equipment removal, and return of keys to maintain electrical and site safety in construction and building maintenance settings.
by Melvin keyani, from the Community
Downloads: 0
Get

ESSW SMS 909: Limitation of Access Permit

Use this Limitation of Access Permit (ESSW SMS 909) to control entry to restricted areas and authorize specific work. The form captures permit holder details, competency checks, and hazards such as electrical, mechanical, manual handling, slips and trips, and work at height. It supports key issuance, isolation verification, and mandates on-site display and lock-and-tag procedures. Sections include authorization to commence, receipt, clearance, and cancellation to ensure the area is secured, left safe, and keys are returned.

by Melvin keyani, from the Community

10+

Get

Template

ESSW SMS 909 - Limitation of Access Permit

This Limitation of Access Permit template (ESSW SMS 909) helps control entry to restricted areas and ensure safe, authorized work. It guides permit holders and authorized persons through competency checks, risk assessment and method statement confirmation, identification of hazards such as electrical, mechanical, work at height, slips and trips, and coordination with other trades. The template covers authorization to commence, additional persons, keys issued, signatures, receipt, clearance, and cancellation, plus responsibilities for securing areas and returning keys. Use it to formalize isolation, communication, and safe access procedures on site.

by Melvin keyani, from the Community

10+

Get

Template

RNM Limitation of Access Permit

This RNM Limitation of Access Permit template helps you manage work in restricted areas and ensure site safety. It guides permit holders and authorized persons through permit details, risk assessments, and competency checks before work begins. Record hazards such as work at height, manual handling, electrical and mechanical risks, and working around other trades. Document issued keys, additional personnel, and the description of works. Capture signatures for authorization, receipt, clearance, and cancellation, including photo evidence that the area is secure. The template reinforces responsibilities for controlling access, locking restricted areas, communicating with other permit holders, and returning keys to the site permit office on completion.

by Peter Bain, from the Community

10+

Get

Template

ESSW SMS 904 Permit to Work

Use this ESSW SMS 904 Permit to Work template to formalize authorization and control of high risk activities on site. Record permit holder details, risk assessment confirmation, location and scope of work, isolation and earthing points, safety locks and caution notices, and keys issued. Capture signatures from the responsible person and the authorised person to start, suspend, or cancel work, and document clearance at shift end. This form helps enforce restricted area access, tool and equipment removal, and return of keys to maintain electrical and site safety in construction and building maintenance settings.

by Melvin keyani, from the Community

Get

ESSW SMS 941 - MSSW Limitation of Access Permit

About author

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