Template

Over-riding Machine Guards Permit to Work

by Richard Smith, from the Community

10+

This permit to work form controls maintenance and diagnostic activities when machine guards are removed or isolated. It highlights primary hazards such as electric shock, arc flash, trapping, crushing, entanglement, and exposure to hazardous substances. It guides workers to confirm training, signage, temporary guarding, engineering modes, emergency stop access, use of insulated tools, and lockout tagout where appropriate. It includes authorization and expiry details, a standby rescuer and rescue plan for live testing, and a hand-back and cancellation section after guards are refitted and interlocks reinstated.

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With SafetyCulture you can

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

Electrical Permit to Work

Use this electrical permit to work template to manage safe electrical tasks from planning to hand back. Capture contractor details, job scope, location, start and end times, and PPE requirements. Verify competence, insurance, and RAMS or SSOW availability. Identify hazards, avoid live work where possible, apply isolation and LOTO, and confirm protection against shock and arc flash. Check tools, lighting, signage, and weather. Obtain authorization from a responsible person before works commence, brief all attendees, and document hand back and cancellation once equipment is reinstated. Suitable for port and logistics sites.

by Liam Reid, from the Community

10+

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Template

Confined Space Permit to Work

This Confined Space Permit to Work template supports safe entry and maintenance in tanks, boilers, and process equipment. It guides teams through hazard identification, isolation and lockout/tagout, ventilation and temperature checks, gas testing and continuous monitoring, PPE requirements and intrinsically safe tools, standby and rescue arrangements, communication checks, and hot work controls. It includes sections for atmospheric tests, rescue plans, authorisation and acceptance, permit expiry, and hand-back and cancellation, helping organisations standardise confined space procedures and compliance.

by Richard Smith, from the Community

10+

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Template

Electrical Work Critical Control Inspection

This critical control inspection checklist helps teams working with or near electricity verify the controls that prevent electric shock and arc flash incidents. Use it to confirm licensed and authorised workers, approval for any live work, correct insulated tools and observers, and that isolation and lockout tagout are in place and verified. Check equipment condition and labeling, access to isolators, overhead and underground service locations and clearances, effective earthing, and adherence to minimum approach distances. Assess arc flash risk, confirm PPE and permits, and rate overall control effectiveness.

by Thomas Harrison, from the Community

20+

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Template

Working at Height Checklist and Permit

This working at height checklist and permit helps you plan and control high risk tasks. Capture job details, assess hazards, and confirm training and area controls. Sections cover roof access, mobile elevating work platforms, fixed and tower scaffolds, forklift man riding cages, and ladders and stepladders. Verify licenses and inspections such as IPAF 3a and 3b, PASMA, and LOLER, monitor weather and wind, and prepare rescue plans. Includes validity times, acceptor sign off, and hand back to close out the permit. Use alongside a general permit to work.

by Darren Downing, from the Community

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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

10+

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Template

Hospital Permit To Work Template

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.

by Stephen Dawson, from the Community

10+

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Over-riding Machine Guards Permit to Work

About author

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