Permit to work template: base template and example

When to use a permit to work

• WorkSafe Victoria says employers must provide permit to work systems for plant exposed to an electrical hazard, with the permit issued in writing and listing the work and the hazards identified.
• Permits also help with isolations and handovers. SafeWork NSW's energy isolation guidelines say to get a permit to work from the supervisor when the risk assessment requires it.
• Apart from confined space entry, most permits aren't required by law. They're a common way to control risky one-off work. See what your state expects below.

Working in a confined space? That needs its own confined space entry permit.

Permit to work rules in your state

Apart from confined space entry, the law doesn't usually spell out a permit to work, but some regulators set expectations for when you use one. We're not a regulator, so check with yours:

• Victoria: employers must provide permit to work systems for plant exposed to an electrical hazard. See WorkSafe Victoria on working on energised plant

• New South Wales: covers when to get a permit before isolating plant in SafeWork NSW's energy isolation guidelines

• Major hazard facilities in any state: permit systems are part of the safety management system. See Safe Work Australia's major hazard facilities guide

• Queensland: WorkSafe Queensland

• South Australia: SafeWork SA

• Western Australia: WorkSafe WA

• Tasmania: WorkSafe Tasmania

• Northern Territory: NT WorkSafe

• Australian Capital Territory: WorkSafe ACT

See every permit type and when to use each on our permit templates page

What a good permit system looks like

• Safe Work Australia's major hazard facilities guide lists a clear work description, defined permit types, isolation confirmed before the permit is issued, and permits issued only by trained, authorised people.
• Plan the handback. SafeWork NSW suggests using a permit to manage shift handover and the safe restart of equipment.
• Use sub-permits for the high risk parts of the job, such as hot work, isolations or confined space entry, and keep them linked to the main permit.

Where permit systems break down, and how to prevent it

Most permit failures come from the system, not the form. These are common weak points, with the kind of control that fixes each:

• The permit is signed without anyone looking at the job: the issuer inspects the area and the isolations before signing.

• The work grows beyond what the permit covers: any new task or change in scope means stopping and reviewing the permit.

• Two permits clash in the same area, such as hot work next to tank cleaning: a permit board or register, and the area owner checking for conflicts.

• Isolations are assumed, not proven: test for zero energy, and reference the lockout tagout permit on the permit to work.

• Shift change loses track of the job: hand the permit over in person, with the incoming person in charge signing on.

• Workers start without signing on: everyone doing the work signs on before starting and off when they finish.

• The permit is closed with no final check: inspect the area, remove isolations in order, and hand the plant back to its owner.

• Permits become a paperwork habit: spot-check open and closed permits, and retrain where shortcuts show up.

What to include in a permit to work

• The site, permit number, and when the permit is valid from and to
• A clear description of the work
• Any sub-permits needed, such as hot work or isolation
• The hazards identified for the job
• Precautions checked, such as isolations, PPE, barricades and emergency procedures
• Sign-off by the issuer, the person in charge and the area owner, plus permit closure

Common gaps in a permit to work

Before work starts, check the permit doesn't have these gaps. Your site may look for more:

• The work description just says 'maintenance' or 'repairs'.

• There's no valid-from and valid-to time, or it's open-ended.

• Sub-permits such as hot work or isolation aren't listed or cross-referenced.

• The workers doing the job haven't signed on.

• The closure section is blank, or signed without an area check.

Filled-in permit to work example

Example only, not for use as your own permit. This is the base template filled in for a fictional job: replacing a conveyor gearbox on a mezzanine 3 m above a packing line. Click the page to enlarge it.

Your own permit must match the actual job and site, and follow your site's permit system.

How to fill one in

1. Fill in the site, permit number, valid times and a clear description of the work.
2. Tick the sub-permits needed, and complete those permits too.
3. Tick the hazards, then check each precaution is in place before work starts.
4. Have the issuer, the person in charge and the area owner sign it, and display it at the work site.
5. When the work is done, check the area is safe, then close the permit out.

Get your permit to work into the app

This form is in the Shadow Forms app. Your team can fill it in on site, add photos and sign it, then send it straight to the office.

The PDF and Word versions are copies only. If you have your own branded version, or want this one adjusted to your business, we can add it to the app. Upload a form, or get in touch.

Doing hot work? Get the free hot work permit template.

Isolating plant? Get the free lockout tagout permit template.