Template

Entry/Access Permit (Limitation of Access)

by Olivia Blazier, from the Community

10+

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.

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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
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+
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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
PC HS 25 Confined Space Entry Permit
This PC HS 25 Confined Space Entry Permit template helps teams plan and authorize safe entry into confined spaces. Record project details, location, work scope, permit number, and date. Verify gas testing for oxygen, H2S, explosivity, CO, and other gases with equipment type and calibration dates. Confirm the safe system of work, removal of noxious substances, and full isolation from energy sources. Checklist items cover access control, communications, standby person, first aid, signage and barriers, PPE, intrinsically safe tools, adequate lighting and ventilation, tripod and retrieval gear, and escape breathing apparatus. Document continuous gas monitoring, pre-entry briefing, worker medical fitness and training, and emergency rescue arrangements. Supervisor authorizes before entry and cancels the permit once work is complete and the area is left safe. Permit validity is limited to one day.
by Kevin Baker, from the Community
Downloads: 0
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Template
V HSF038 Confined Space Permit
This V HSF038 confined space permit helps teams plan and control safe entry to confined spaces. It captures work details, location, hazards and isolations, and requires a written safe system of work with risk assessment and method statement references. The form guides atmospheric testing, ventilation, PPE, communication, rescue arrangements and equipment checks. It records authorization by a permit coordinator, supervisor briefing and receipt, completion of work and permit cancellation. Use this checklist style permit to document controls and compliance before, during and after entry.
by Olivia Blazier, from the Community
Downloads: 10+
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Entry/Access Permit (Limitation of Access)

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