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Permit-to-Work — Generic Template

Document Information

Field Value
Document Reference FORM_PTW_01
Issue Number 1
Issue Date 4 May 2026
Next Review 4 May 2027
Controlled By Sean Ashton (HSQE Consultant)
Approved By Aaron Mason, Managing Director

What this is

A single AMWS Permit-to-Work template covering the three permit-controlled activities the company performs: excavation, hot work, and confined space. Cross-referenced from MS 2.9 (excavation), MS 2.24 (hot work) and MS 3.3 (confined space). Maps to Achilles UVDB B2.7.6 evidence test. The template is filled in for every relevant job; completed permits are filed against the job pack and retained per SOP 4.7 Control of Records.

When a permit is required

Activity Permit required? Trigger
Excavation Yes — always Any breaking of the ground, regardless of depth, on a public-highway or third-party site
Hot work Yes Any work generating sparks, flame or heat that could ignite combustibles — welding, oxy-fuel cutting, grinding, brazing, soldering, blowtorch use
Confined space Yes Entry to any space meeting the Confined Spaces Regulations 1997 definition (manholes, chambers, tanks)
Other Not normally Routine surface works on AMWS sites — covered by RAMS only

How to use

  1. Issuer (Site Supervisor or deputy) completes Sections 1–4 before work starts
  2. Worker(s) read, sign Section 5 — they own the permit on site
  3. On completion, both parties sign Section 6 → permit closed
  4. Closed permit attached to job pack; copy filed in docs/audit-readiness/ptw-records/<YYYY-MM>/ptw-<jobref>.md

FORM_PTW_01 — copy this block into a fresh permit

# Permit-to-Work — <PTW number> — <Date>

| Field | Value |
|-------|-------|
| **Permit number** | PTW-<YYYY>-<###> |
| **Job reference** | <RAMS / job-pack ref> |
| **Site / location** | <site address + grid ref or postcode> |
| **Client** | <Anglian / Severn Trent / etc.> |
| **Issuer (printed name)** | <Site Supervisor / deputy> |
| **Date of issue** | DD/MM/YYYY |
| **Valid from** | DD/MM/YYYY HH:MM |
| **Valid until** | DD/MM/YYYY HH:MM (max 12 hours; re-issue if work continues next day) |

## Section 1 — Activity (tick one)

- [ ] **Excavation** — depth: ____ m; cross-ref MS 2.9 + POL_HSQE_06 Underground Cables + POL_HSQE_13 Excavation
- [ ] **Hot work** — type: ____ (welding / cutting / grinding / brazing / soldering); cross-ref MS 2.24 + SOP 8.15 Fire
- [ ] **Confined space** — space: ____ ; cross-ref MS 3.3 + SOP 8.12 Confined Space

## Section 2 — Hazards identified

| # | Hazard | Source |
|---|--------|--------|
| 1 | … | … |
| 2 | … | … |

## Section 3 — Controls required (tick all that apply)

### Excavation
- [ ] Service drawings obtained and reviewed
- [ ] CAT/genny scan completed; CAT serial: ____ ; battery checked
- [ ] Hand-dig first 600 mm within 1 m of known service
- [ ] Excavation supports identified (battering / shoring / trench box) — type: ____
- [ ] Edge protection rigid (no soft barriers within 2 m)
- [ ] Spoil set back ≥ 1 m
- [ ] Atmospheric testing (deep excavations) — required Y / N
- [ ] Permit holder briefed on emergency egress

### Hot work
- [ ] Combustibles removed or covered with fire-retardant blanket within **10 m radius**
- [ ] Approved fire extinguisher to hand and tested (CO₂ / dry powder for the work type)
- [ ] Ventilation adequate for fume control
- [ ] Power source isolation — provisional shutdown of any flammable supply nearby
- [ ] **Fire watch maintained throughout work AND for 60 minutes after completion**
- [ ] Permit closed only after final fire-watch is complete

### Confined space
- [ ] Risk assessment for confined-space entry on file (MS 3.3)
- [ ] Atmospheric testing before entry: O₂ 19.5–23.5%, LEL <10%, CO <30 ppm, H₂S <10 ppm
- [ ] Continuous monitoring during entry — gas-meter on entrant
- [ ] Top-man (attendant) at entrance — does **not** enter
- [ ] Communication method confirmed (radio / shout-and-respond)
- [ ] Rescue plan agreed; rescue equipment on site (tripod / harness if required)
- [ ] Emergency contact + ambulance route briefed

## Section 4 — Authorisation

| Field | Name | Signature | Date / time |
|-------|------|-----------|-------------|
| **Issuer (Site Supervisor)** | | | |
| **Authorising Director** (high-risk hot work / deep excavation / Confined Space CAT 2+) | | | |

## Section 5 — Permit holder acceptance

By signing, I confirm that I have read this permit, understand the hazards and controls, am competent for the activity, and will work within the permit's limits.

| Name | Role | Signature | Date / time |
|------|------|-----------|-------------|
| | | | |

## Section 6 — Close-out

| Field | Value |
|-------|-------|
| **Time work completed** | DD/MM/YYYY HH:MM |
| **Hot-work fire-watch end** (if hot work) | DD/MM/YYYY HH:MM (must be ≥60 min after completion) |
| **Site reinstated / area handed back** | Y / N |
| **Issues / near-misses during work** | … |
| **Permit holder sign-out** | <name + signature + date/time> |
| **Issuer sign-out** | <name + signature + date/time> |

---

*Filed under `docs/audit-readiness/ptw-records/<YYYY-MM>/ptw-<jobref>.md`.*

Why this matters for the audit

Achilles UVDB B2.7.6 (and CDM 2015 Reg 13 for the principal contractor) expects:

  • A single coherent permit format (this template) rather than three different scraps for three different activities,
  • Issued before work starts, signed by issuer + holder,
  • Closed out after work, with hot-work fire-watch evidence captured,
  • Retained as part of the job pack.

Spot-sampling: the auditor can pick any recent excavation, hot-work or confined-space job and ask to see the permit. With this template plus the closed-out records folder, the answer is "here it is".

Cross-references

Back to Audit Readiness · B2.07 Workplace Safety