Permit to Work and Isolation Request
v3.4
Purpose. Tradespeople complete this form to request a permit to work and the isolations they need before any work on plant.
1.When to use this form
Use this form for every task on plant. Submit it to the shift supervisor at least one shift before the work is planned so that the isolation can be planned and the control room can schedule it around operating plant. Emergency work must still use this form before the permit is issued.
2.Describing the work
State the plant item by its tag number, the task from the work order and the boundary of the work. Attach the drawing marked with the plant and the isolation points you expect.
3.Energy sources
Tick every energy source present and state how each must be isolated and proven. The isolator will verify the list against the drawings and add any source you have missed. The permit will not be issued until every source has an isolation point.
4.Hazards and controls
Identify confined space, work at height, hot work, high voltage access, chemicals and lifting. Each hazard requires the additional certificate or control listed in the procedures before the permit is accepted.
5.Authorisation and close out
The issuer, isolator and recipient sign the permit. The permit is valid for the shift unless extended. The recipient must sign the work complete and remove every personal lock before restoration.