Hazardous Materials

I declare that the above has been made known to the competent person in charge of the work and consider the above mentioned area to be safe for the competent person to commence work.

Signed:

Date:

Permit Controller:

Time:

Acceptance by competent person prior to commencement

I understand the work that is to be carried out and the safety precautions that are necessary to complete the work safely as outlined in the appropriate method statement and risk assessments. If conditions are such that the method statement and risk assessments become invalid it is my responsibility to stop work immediately and notify the person who authorised this permit to work. The disposal of any residues of the hazardous materials used will be in accordance with the Environmental Protection Act.

Signed:

Date:

Competent Person:

Time:

Continuation of Work

I hereby authorise the work specified above to continue until the time stated below and that I have checked the safety arrangements and confirm that they remain adequate.

Permit has been extended to:

am / pm

Signed:

Date:

Permit Controller:

Time:

I have checked the safety arrangements and am satisfied and agree to accept responsibility to complete the specified work by the revised time.

Signed:

Date:

Competent Person:

Time:

Permit Cancellation

This permit is cancelled. The work is / is not complete. Safety precautions have / have not been removed.

Signed:

Date:

Permit Controller:

Time:

Completion of Work
Final check by Contractor / Employee

I declare that the work described above is complete all work equipment, persons and materials under my control have been withdrawn. All safeguards have been reinstated and the work area returned to a safe status and service.

Signed:

Date:

Competent Person:

Time:

Completion of Permit - Permit Controller

I declare that the permit is now closed and I have received copies of the permit back from the Competent Person. The area has been inspected and is free from risk and all fire protection systems have been reinstated to their normal operating status.

Signed:

Date:

Permit Controller:

Time:

Page 2

Hazards Identified:

Note: If asbestos is involved do not proceed contact the Company Health and Safety Department or equivalent

Hazard Classification

Very Toxic

Toxic

Irritant

Harmful

Corrosive

Flammable

Explosive

Oxygen Deficient

Pressure Container

Note: Obtain product data sheet

Have activities involving materials / hazards been risk assessed? YES / NO

Has a Method Statement been created for the whole activity? YES / NO

Have all relevant people been informed? YES / NO

If the hazard presents a risk to the Environment then an Environmental Permit is also needed.

Where isolations are required the a Plant Isolations Permit is also needed

The disposal of any residues and hazardous materials must be in
accordance with the Environmental Protection Act

Quick and complete control of permits and contractors software tool. Click here to watch the guided tour

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Guides:

Sample Permits to Work:

Complies with NFPA 51B - Standard for Fire Prevention During Welding, Cutting and Other Hot Work

Does the work involve contact with Asbestos? YES / NO

Acceptance by competent person prior to commencement

Continuation of Work

Permit Cancellation

Completion of Work Final check by Contractor / Employee

Completion of Permit - Permit Controller

Page 2

Note: If asbestos is involved do not proceed contact the Company Health and Safety Department or equivalent

Hazard Classification

Completion of Work
Final check by Contractor / Employee