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CAQA Apex Manufacturing · Simulated workplace

Permit to Work Form

FormControlled document
APX-FRM-041
v3.1
Document ownerSafety and Environment Manager
Version3.1
Approved18 March 2026
Next review18 March 2027
StatusCurrent

Purpose. Authorises non-routine work on plant or in hazardous areas after the hazards, isolations and controls have been confirmed by the permit issuer and the permit holder.

1.When a permit is required

A permit to work is required for any work involving isolation of plant, hot work, confined space entry, working at height above two metres, excavation, work on pressurised systems, work by contractors on operating plant and any task the supervisor considers non-routine. Routine production tasks covered by a current procedure do not require a permit.

2.Roles

The permit issuer is an authorised person from the operating department who owns the plant. The permit holder is the person supervising the work. Both must walk the job together before the permit is issued. The permit must be signed by both and displayed at the work site for the duration of the work.

3.Attached permits

Where the work involves confined space entry, hot work or working at height, the specific permit or checklist for that hazard must be completed and attached. The permit to work is not valid without the attached permits.

4.Validity

A permit is valid for a single shift unless extended by the permit issuer in writing. A permit must be suspended when the site emergency alarm sounds, when conditions change or when the permit holder leaves the work site. Work must not restart until the issuer revalidates the permit.

5.Closing the permit

When the work is complete the permit holder must confirm that the area is clean, guards are refitted and all people and tools are clear, then return the permit to the issuer. The issuer must inspect the work site, close the permit and record it in the permit register before the plant is returned to service.

6.Complete the form

APX-FRM-041 v3.1 · CAQA Apex ManufacturingUncontrolled when printed. Simulated document created by CAQA for training and assessment.