Template

Permit To Work Certificate

by Ian Glaves, from the Community

10+

This Permit to Work Certificate template helps organizations control high‑risk tasks performed by contractors and maintenance teams. It captures responsible persons, work details, validity times, and whether additional permits are needed (hot work, work at height, confined space, fragile roof, high voltage, excavation). The checklist guides pre‑work controls such as RAMS review, inductions, training verifications (e.g., IPAF 3A), equipment isolation and lockout, draining pipelines, notifications, barricades, signage, access and lighting, concurrent permits, and required PPE. It includes handover, on‑site supervision, compliance checks, and final sign‑off confirming the area is left safe. Document ref: JF-HS-CON-REC-03, Version 6 (12.02.2024).

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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
Permit to Work Certificate (Manufacturing)
This Permit to Work Certificate template supports safe contractor management for food manufacturing sites such as Jigsaw Foods. It captures project details, responsible persons, induction status, RAMS, PPE checks, isolations, and site access controls. Built-in permit options cover hot work, work at height, confined spaces, high voltage, excavation, and fragile roof activities. The form guides users through hazard identification, equipment isolation and lockout, scaffolding and ladder checks, ventilation and fire watch arrangements, and compliance with local regulations. It includes sections for required certifications (IPAF, PASMA), PPE requirements, barricades and cordons, notifications to other departments, and post-work sign-off to confirm the area is left safe and tidy.
by Ian Glaves, from the Community
Downloads: 0
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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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Template
Permit to Work Template for Hot Work and Confined Space
This Permit to Work template helps control high risk activities on site, including hot work, energy isolations, confined space entry, and working at heights. It covers inductions, PPE checks, isolation and detector status, hot work patrols, housekeeping, and sign offs for supervisors and subcontractors to support compliance and safer operations.
by Craig Corner, from the Community
Downloads: 30+
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Template
Permit to Work Checklist
Use this Permit to Work checklist to plan, authorize, and control high risk activities on site. It covers PPE requirements and verification, energy isolation and lockout tagout approvals, hot work controls with extinguishers, barricades, and post work fire watch, excavation planning and service locating, and working at heights training, equipment checks, and edge protection. Include inductions, worker counts, area lighting, hazard signage, and housekeeping. Close out by restoring alarms and isolations, cleaning the area, and confirming the site is safe to resume operations.
by Colin Handley, from the Community
Downloads: 0
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Permit To Work Certificate

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