Template

Hospital Permit To Work Template

by Stephen Dawson, from the Community

10+

This Permit To Work template helps hospitals authorize and control contractor and maintenance activities. It captures permit details, contractor and competent person information, work scope and location, and RAMS submission and approval. It links associated high risk permits including hot works, working at height, confined spaces, isolated and live equipment. The form includes approvals, declarations, signatures, and clear acceptance of responsibilities. It guides permit clearance and closure, and verifies completion, safety, and any fire stopping measures such as sleeves, collars, covers, and sealants. Security checks confirm permits returned and closed.

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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

Community

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
Work at Height Permit to Work
Use this permit to plan and control work at height. The template captures site and contractor details, scope of work, and required control measures such as barriers, access limitations, ladder condition, plant setup, falling object protection, weather checks, housekeeping, and RAMS attachments. It documents authorization by an approved person, acceptance by the competent person, time extensions, and final completion and closure to ensure the area is left safe and equipment returned to service.
by Luke Penrose, from the Community
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Template
General Access Permit
Use this General Access Permit checklist to manage controlled access to sites. Capture company and competent person details, permit number and dates, and the scope and location of works. Confirm that proposed works are non-intrusive or direct users to submit RAMS and obtain a full permit when required. Record approvals and acceptance, and have personnel acknowledge hazards, control measures, PPE, and emergency procedures. Close out the permit with sign-off, date and time, and run security checks to ensure permits, passes, and keys are returned. Includes space for additional comments.
by Stephen Dawson, from the Community
Downloads: 10+
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Template
Electrical Testing and Inspection Permit
This Electrical Testing and Inspection Permit template helps control and authorize electrical work on site. It guides permit issuers and holders through key checks such as panel labeling, presence of covers and guards, isolation and lockoff of incomplete circuits, signage in work areas, and photographic evidence of panel condition. It captures RAMS review and approval, key sign-out, permit holder details, and contact time stamps. The workflow includes declaration of responsibility, signatures for receipt and clearance, confirmation that areas are locked off and keys returned, and formal cancellation. Clear responsibilities for the permit holder emphasize restricting access, maintaining key control, housekeeping, communication with other permit holders, and returning the permit and keys to the authorized person at the permit office upon completion.
by Aaron Lee, from the Community
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Template
Safety Work Permit Template
This safety work permit template helps you control high risk work by formalizing request, review, and authorization. It guides supervisors and permit authorities through documenting the work activity, identifying high risk tasks such as hot work, confined space, excavation, plant isolation, work at heights, and live electrical work, and confirming risk assessments and controls are in place. Capture names, dates, approvals, and signatures, register the permit, and communicate scope and supervision requirements. Use it to verify controls before start of work, monitor hazards during the job, and close out with final sign off.
by Mohamed Elhassan, from the Community
Downloads: 10+
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Hospital Permit To Work Template

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Work at Height Permit to Work

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Work at Height Permit to Work

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