Permit to Work and Isolation Certificate Form
v4.1
Purpose. Authorises work on plant and records the isolations, preparation, gas tests and controls that were in place before the work started and how the plant was returned to service.
1.When to use this form
Complete this form for any work that requires a permit under the permit to work and plant isolation procedure. One form covers one job on one item or system of plant for one shift. The isolation certificate section must be completed for every job that requires isolation and must list every isolation point with its tag number.
2.Walking the job
The permit issuer and the permit holder must walk the job together before the permit is issued, confirming the work location, the isolations, the preparation of the plant and the controls. The form must be completed at the job, not in the office.
3.Gas testing
Where flammable or toxic vapour is possible, a gas test must be completed by an authorised gas tester immediately before the permit is issued and at the intervals stated on the permit. Results must be recorded with the detector number and calibration date.
4.Suspension and cancellation
The permit must be suspended when the site alarm sounds, when conditions change or when the work stops for more than one hour. Work must not restart until the issuer revalidates the permit. A permit must be cancelled if the scope of work changes and a new permit raised.
5.Closing the permit
The permit holder must sign the work complete section confirming the area is clear and joints are remade and tagged. The isolation authority must record de-isolation and blind reconciliation. The issuer must inspect the site, close the permit and enter it in the permit and isolation register.