General Work Permit

Section 1: Permit & Job Information

Project / Job Title

Permit No.

Work Area / Facility

Specific Location / Equipment ID

Valid From Date

Valid From Time

Valid To Date

Valid To Time

Section 2: Work Scope & Personnel

Detailed Description of Work to be Performed

Work Supervisor / Applicant Name

Authorized Person Name

Additional Crew Members

Section 3: Hazard Identification & Controls Checklist

Confined Space Entry Working at Height / Elevated Work Electrical Hazards / LOTO Hazardous Chemicals / Materials Heavy Lifting / Manual Handling Excavation / Breaking Ground Moving Machinery / Vehicles Hot Work / Fire Potential Emergency procedures reviewed

Specific Safety Notes or Precautions

Section 4: Authorization & Acceptance

Permit Issuer

Name

Signature

Date & Time

Work Supervisor / Applicant

Name

Signature

Date & Time

Section 5: Permit Closure & Handover

I hereby confirm that all work is completed and the work area has been left in a safe condition.

Permit Closed By (Work Supervisor)

Name

Signature

Date & Time

Handover Accepted By (Area Supervisor)

Name

Signature

Date & Time