Template

RNM Limitation of Access Permit

by Peter Bain, from the Community

10+

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.

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Confirm accountability and compliance with a digital log

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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
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+
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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
Downloads: 0
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Template
Entry/Access Permit (Limitation of Access)
This Entry/Access (Limitation of Access) Permit template helps appointed persons control entry to restricted or hazardous areas. It captures permit references, work team details, location signage, and requires approved risk assessments and method statements. The checklist verifies access and egress, calibrated monitoring equipment, removal of harmful substances, worker competence, PPE, service isolations, communications, barriers and signage, intrinsically safe lighting, and related permits such as hot work or gas-free certification. It includes acceptance, completion, and cancellation steps, and limits permits to a single shift (maximum 12 hours), supporting safe, compliant site operations.
by Olivia Blazier, from the Community
Downloads: 10+
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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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RNM Limitation of Access Permit

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