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.

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.

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.

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

Permit Cancellation

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

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declare that the work described above is complete all work equipment, persons and materials under my control have been withdrawn.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.

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.

PLANT TO BE ISOLCATED FROM FORMS OF ENERGY* OR HAZARDOUS SUSBSTANCES

* FOR THE ISOLATION OF ELECTRICAL ENERGY COMPLETE THE ELECTRICAL PERMIT TO WORK

The following flow chart should be used as a guide: