UNIVERSITY OF LEICESTER

PERMIT TO WORK
PROCEDURE AND REQUIREMENTS
ESTATES & FACILITIES MANAGEMENT DIVISION

PREPARED BY:

MR STEPHEN REES
HEAD OF MAINTENANCE
ESTATES & FACILITIES MANAGEMENT DIVISION
UNIVERSITY OF LEICESTER

ON BEHALF OF:

MR P GOFFIN
DIRECTOR OF ESTATES
ESTATES & FACILITIES MANAGEMENT DIVISION
UNIVERSITY OF LEICESTER

REF: PROCEDURES ISSUE: 1 DATE: JAN 2011

Contents
1.0 Introduction
2.0 Condition for a Permit
3.0 Competent Persons
4.0 Maintenance Staff
5.0 Contractors
6.0 Issuing a Permit
7.0 Monitoring the Work
8.0 Completed Work
9.0 Out of Hours Working
10.0 Permit to Work Requirements
10.1 HV & LV Enclosures Permit PW01
10.2 Hot Works Permit PW02
10.3 Roof Access Permit PW03
10.4 Plantroom Permit PW04
10.5 CL3 Lab Permit PW05
10.6 Confined Spaces Permit PW06
10.7 Asbestos Permit PW07
Appendix

Page 1
 UNIVERSITY OF LEICESTER
ESTATES AND FACILITIES MANAGEMENT DIVISION

Permit to Work

1.0 Introduction

The Permit-to-Work procedure provides a formal control system aimed at the

prevention of injuries and damage to property arising from accidents where
foreseeable hazardous work is carried out.

The Permit-to-Work consists of documents which:

Detail the work to be done.

Details the precautions to be taken.
Identifies all the hazards and foreseeable risks.
States the control measures to be implemented.
Cancellation.
Lists other permits in operation.

Permits themselves do not make a job free from risks, they rely upon effective
control and co-ordination in order that hazards are identified and risks are
suitably assessed.

The Health and Safety Executive identify the following required elements for a
Permit-to-Work:

Type of Permit – i.e. Hot Work, Asbestos etc.

Unique Permit Number.
Location of work.
Details of the work to be carried out.
Identification of hazards.
Precautions required.
Personal Protective Equipment required.
Authorisation to commence work.
Any extension of permit time.
Handback
Cancellation.

2.0 Condition for a Permit

The University will expect a Permit-to-Work to be issued in the following

situations:

Working in confined spaces.

Hot Works.
High and Low voltage electrical work.
Working with Asbestos.
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 Excavations.
Work on roofs.
Scaffold Towers
Other situations as determined on site.

A Permit-to-Work will not be issued to contractors for operations on the Campus

within a secure and clearly identified site from which staff, students and non-
authorised visitors are excluded and for which the Contractor is deemed to be
entirely responsible.

3.0 Competent Persons

The use of Competent Persons is a prime requirement of the Permit-to-Work

system. Although Competency has never been defined in either case or statute
law, the Health and Safety at Work Regulations define a person as being
Competent when that person:

“Has sufficient training and experience or knowledge as to enable him to assist in

securing compliance, on the part of the employer, with the necessary safety
legislation and maintenance procedures.”

The University of Leicester expects those persons designated as Competent to

have had:

Valid and certificated training, where this is deemed necessary, including

an element of health and safety appreciation, relevant to the Permit to be
issued.
Experience of the work to be carried out.
Knowledge of the Permit-to-Work procedures.

The number of Competent Persons available to issue and sign a Permit-to-Work

will vary depending upon the type of permit required and whether it is for
Contractors or Maintenance staff. Trade Foreman and Services Maintenance
Managers will be defined as Competent Persons, as will Building Surveyors,
Project Managers and Building Services Engineers within the Development Team.

4.0 Maintenance Staff

When maintenance staff need to carry out work that requires a permit, it will be
issued and signed by the relevant Trade Foreman, or Services Maintenance
Manager.

5.0 Contractors

When a contractor requires a permit they shall provide the relevant Estates
Project Manager or Engineer with a suitable and sufficient assessment of the risks
inherent with the work and a method statement for the works to be undertaken.
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 This information should, whenever possible, be submitted at least 48hrs before
the start of the work and will allow the Competent Person sufficient time to
assess the work in detail. For work involving Service Maintenance contractors,
Method Statements shall be provided for specific tasks at the beginning of the
contract and if necessary Permits-to-Work issued as and when required.

6.0 Issuing a Permit-to-Work

The following procedures should be followed when issuing a Permit-to-Work:

A permit should be obtained from the Project Manager/Engineer and its

number logged. This permit will be uniquely numbered.

The Competent Person should ensure that no other permits have been
issued that will have an impact on the one required.

The permit to be completed correctly with all the relevant information

regarding the work to be carried out, including the exact location and the
nature of the work.

All the copies of the permit should be signed by the relevant Competent
Persons, and if necessary the Contractors representatives to confirm that
contractors and staff understand the implications of the conditions listed
on the permit.

The correct copy of the permit is to be displayed prominently at the work.

The precise time limits for which the permit is valid are to be indicated
and observed at all times.

If issued for a contractor, the company name is to be included.

If issued for a contractor, the contractor‟s supervisor is to be identified.

7.0 Monitoring the Work

As far as is reasonably practicable, the Competent Person shall be responsible for

monitoring the work at regular intervals, to ensure that the operatives are
adhering to the conditions of the permit.

8.0 Completed Work

When the work has been completed the Competent Person will inspect the site to
ensure that:

The works have ceased.

All tools and equipment have been removed.
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 The work area has been left in a satisfactory and safe condition.

When the Competent Person is satisfied that these conditions have been met the
permit will be cancelled and copies filed with the contract documents (if
appropriate) and in the Permit file. These permits should be kept for 12 months.

9.0 Out of Working Hours

Whenever possible, work that requires a Permit-to-Work should be carried out

only during normal working hours. However, there will be occasions when this is
not possible and the Competent Person must ensure that he is available to
monitor contractor or staff compliance throughout the duration of the permit
irrespective of when it takes place.

10.0 Permit to Work Designations.

10.1 HV & LV Enclosures Permit – PW01

High Voltage

The Permit-to-Work system for High Voltage applies to contractors and Estates
staff who may have need to enter any High Voltage substations. It DOES NOT
allow for switching of the H.V. circuits or for maintenance of the equipment, this
can only be carried out by authorised ABB Ltd. staff, or other contractors
appointed by the university.

The duration of the Permit-to-Work will be no longer then a maximum of one

day. For work that may take longer than the one day, a separate permit shall be
issued for each day.

Requirements to be met to enable access to the sub-station:

The Competent Person must ensure that access to the substation will not in
any way affect the H.V. switchgear or controls.
The Competent Person must stay at the substation if access is required for
1 hour or less. For periods of more than 1 hour the Competent Person must
be available on the campus and be within immediate communication with
those in the substation.
Only those staff named on the Permit-to-Work will be allowed in the
substation.
The substation must not be left unlocked and unattended.

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 Low Voltage

Low voltage is regarded as a voltage exceeding 50v AC or 120v DC between

conductors or earth, but not exceeding 1000v AC or 1500v DC between conductors
or 600v AC or 900v DC between any conductor and earth.

Requirements to be met when working on low voltage electrical installations:

The Competent Person must ensure that before disconnection or isolation

of any distribution board or circuit that feeds a distribution board, the
electrical equipment affected has been identified and if appropriate the
users notified.
That staff and contractors are aware of the need to lock-off all isolation
switches in the OFF position.

The Competent Person should issue a Permit-to-Work when any of the following
work is carried out on low voltage electrical installations:

Switching off any switch fuse, distribution board, or mains circuit board
that may affect the University‟s IT systems, the safety of any person, or
the electrical supply to fire alarm systems.
Work on remote and automatically controlled low voltage switchgear.

The duration of the Permit-to-Work will be issued for a maximum of 5 working

days and should be location specific.

10.2 Hot Works Permit – PW02

Hot Work is defined as work that involves temperatures that could give rise to
risks of fire and ignition of flammable substances and combustible materials, and
includes work where there is a naked flame or generation of sparks, smoke or
fumes.

The following works shall be subject to a Permit-to-Work system on the University

campus:

Use of brazing and soldering equipment

Bitumen boilers
Electric arc welding
Gas welding or cutting
Hot air welding
Disk cutting in confined spaces where there is a risk of fire or explosion.

The duration of the Permit-to-Work will be no longer than a maximum of one

day, subject to the one exception below.

All work must cease at least 1 hour before the end of the working day and
the permits are location specific.

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 Where work lasts for more than one day i.e. re-roofing with a bitumen
boiler, the Competent Person signing on behalf of the Estates Department
may issue a permit covering 5 consecutive working days.
The Permit-to-Work shall not apply to hot work in the fitters workshop at
the Maintenance Centre.

Before the permit is signed, the Competent Person shall inspect the working area
for the following control measures:

Area is adequately ventilated.

Gas cylinders are secured in a vertical position on a trolley and equipment
is in good condition.
Floors are clean and free from combustible materials.
All floor and wall opening are covered.

When Hot Work occurs in a confined space

A Permit-to-Work (Confined Space) has been issued.

When Hot Work occurs on a roof

Gas cylinders are sited at least 3 metres from the burner.

Heat insulated base is provided.
A Permit-to-Work (Roofs) has been issued.

Fire Control

The Competent Person shall ensure that the following general controls are in
place:

Suitable and sufficient fire extinguishers are in place.

Staff carrying out the work are trained in their use.
Adjacent smoke heads are isolated and covered to prevent false alarms,
and re-instated and uncovered when work has finished.
All fire doors are closed.
Arrangements are in place to ensure that hot work is not left unattended
during tea/lunch breaks.
Staff carrying out the works are aware of the emergency telephone
numbers and have the means to contact them.
Arrangements are in place to carry out a check of the area at least 1 hour
before the cessation of work each day.
That contractors staff are fully aware of the fire procedures for the area in
which they are working.

10.3 Roof Access Permit – PW03

This Permit-to-Work is intended for Maintenance Staff and Contractors who have
a need to work on roofs at any University Academic or Residential Property,

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where a perimeter hand rail or edge protection is not provided or where the roof
of the building is considered as dangerous.

Requirements to be met for all roofs before work can start:

General – for all buildings

i) Details of PPE
ii) Other permits as necessary i.e. hot works etc.
iii) Permit signed by Competent Person

Additional requirements for specified buildings:

Percy Gee Building

i) If working within 2 metres from roof edge, 2 persons necessary.

ii) Persons working 2 metres from roof edge must use the man safe systems
provided.
iii) Only staff trained in the use of man safe systems will be allowed to use the
equipment.
iv) Contractors must use their own certificated safety harness and lanyards to
attach to the man safe system. Certificates to be checked by Competent
Person before signing permit.
v) Weather conditions to be assessed - no access allowed in high winds or
rain.

Attenborough Tower

i) Two persons necessary.

ii) Weather conditions to be assessed - no access allowed in bad weather, high
winds or rain.
iii) Safety harness required when working at upper roof level.
iv) Contractors must use their own certificated safety harness and lanyards to
attach to safety bolts when working at upper roof level. Certificates to be
checked by competent person before signing permit.

Attenborough Seminar Block

i) Two persons necessary

ii) There is no man safe system or edge protection. Do not work within 2
metres of roof edge.
iii) Weather conditions to be assessed - no access allowed in bad weather, high
winds or rain.

Physics Building & Bennett Buildings

i) Two persons necessary when working outside of designated hand railed

walk ways.
ii) There is no edge protection or man safe systems outside of the walk ways.
Do not work within 2 meters of roof edge.
iii) No access outside of designated walk ways allowed in bad weather, high
winds or rain.
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 Engineering Building

i) Two persons necessary.

ii) No access allowed between glazed north lights. If access required to repair
glazing, particular risk assessment required.
iii) Keep to designated hand railed walk ways.

Concrete Laboratory

i) Two persons necessary

ii) Roof construction is fragile, use crawl boards.

Stamford Hall – Lasdun Blocks

i) Two persons necessary.

ii) There is no man safe system or edge protection. Do not work within 2
metres of roof edge.
iii) Weather conditions to be assessed - no access allowed in bad weather, high
winds or rain.

College Hall Blocks

i) Two persons necessary.

ii) There is no man safe system or edge protection. Do not work within 2
metres of roof edge.
iii) Weather conditions to be assessed - no access allowed in bad weather, high
winds or rain.

Medical Sciences Building

i) Upper roofs have no edge protection or lanyard man safe systems. Do not
work within 2 metres of roof edge.
ii) Weather conditions to be assessed - no access allowed in bad weather, high
winds or rain.

Roof permits shall be issued for a maximum of 1 working day.

10.4 Plantroom Work Permit – PW04

All work within plantrooms, service ducts and risers shall be subject to a Permit-
to-Work.

Plantrooms etc are under the control of the Maintenance Section and any works
carried out by contractors either direct for the Maintenance Section or vie
Development will require a Permit-to-Work issued by an authorised person.

Persons authorised to issue permits for work in plantrooms are:

Mr Stephen Rees: Head of Maintenance

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 Mr Bill Brookes: Electrical Service Maintenance Manager
Mr Steve Bishop: Mechanical Services Maintenance Manager

In absence of the above, permits can also be authorised by the following:

Mr Darren Hughes: BMS & Controls Manager

Mr James Ruddle Buildings Maintenance Manager

10.5 Category 3 Laboratory – PW03

All work within the category 3 laboratory located in Medical Science Building shall
be subject to a Permit-to-Work.

Maintenance Staff

Before any work is carried out in the Category 3 suite, a Permit-to-Work should be
issued by the Containment Level 3 Suite Manager (C3SM) or appointed deputy.

Contractors

When contractors require a permit they shall provide the relevant Estates Project
Manager or Maintenance Services Manager with a suitable and sufficient
assessment of the risks inherent with the work and a method statement for the
works to be undertaken. This information should be submitted at least 72 hours
before works start to enable the Estates Project Manager / Maintenance Manager
to approve the details before C3SM issues the permit.

Other permits as necessary for the works to be undertaken shall be issued by the
authorised person in the E&FMD, i.e. hot works, roof permits etc.

C3 lab permits shall be issued for a maximum of 5 working days. If the works
extend beyond this number, additional permits will be required.

10.6 Confined Spaces Permit – PW06

All work within a confined space shall be subject to a Permit-to-Work. A confined

space at the University of Leicester has been identified as:

Oil Storage Tanks.

Water Storage Tanks – any tank where total access is possible.
Sewage Pumping Stations.
Manholes – any manhole where total access is possible.
Boilers.
Lift pits.
All external ducts.
Ventilation ducting.
Any other situations as specifically identified.

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No person working for the University, either staff directly employed or
contractors shall enter, or be instructed to enter a confined space for any
purpose:

Until they have received a valid Permit-to-Work.

Unless it is not reasonably practicable to undertake the necessary work
without such entry.

Requirements to be met to enable work to commence:

a) Oil Tanks

Details of PPE.
Method statement of work to be carried out.
Monitoring of the atmosphere.
Observer outside with means of communication.
Rescue plan.

b) Water Tanks

Details of PPE.
Inlet/outlet valves locked-off.
Method statement of work to be carried out.
Observer outside with means of communication.
Rescue plan.

c) Sewage Pumping Stations

Details of PPE.
Method statement of work to be carried out.
Monitor atmosphere.
Observer outside with means of communication.
Rescue plan.

d) Manholes

Details of PPE.
Method statement of works to be carried out.
Observer outside with means of communication.
Rescue plan.

e) Boilers

Authorised persons only.

Details of PPE.
Method statement of work to be carried out.
Observer outside with means of communication.
Rescue plan.

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f) Lift Pits

Authorised persons only.

Details of PPE.
Lift props to be used.
Lift to be electrically isolated.
Method statement of work to be carried out.
Observer outside with means of communication.

g) Ventilation Ducts

Details of PPE.
Method statement of works to be carried out.
Observer outside with means of communication.
Ventilation plant to be electrically isolated.
Rescue plan.

The duration of the Permit-to-Work will be no longer than one working day.
Additional permits will need to be issued daily if work exceeds this time
period.

10.7 Asbestos Permit – PW07

All work with asbestos materials shall be carried out in accordance with the
requirements of current legislation, in particular:

The Control of Asbestos Regulations 2008 and Approved Codes of Practice.

The Asbestos (Licensing) Regulations 1983.
Approved Code of Practice: Working with Asbestos Insulation, Asbestos
Coating and Asbestos Insulation Board.

All work involved with the removal of asbestos materials will be undertaken by
licensed asbestos removal contractors, but some University Estates staff will
come into contact with products containing asbestos during their normal working
practices.

Competent Person Duties

Before a permit is raised the Competent Person shall:

1. Confirm that the material to be removed/worked with has an asbestos

content by referring to the Asbestos Register. If the area is not listed in the
Register but the Competent Person has a suspicion that the material may
contain asbestos, it should be analysed before the permit is issued.

2. If the analysis of the material confirms that asbestos is present the

Asbestos Register should be updated.

Page 12
3. University of Leicester policy is that all works involving asbestos will be
undertaken by licensed contractors. The Competent Person shall employ a
suitable contractor to undertake the works.

4. The contractor shall provide a detailed Safety Plan for the operations to
include:

Scope of work.
Programme of work.
Proposed method of removal.
Waste disposal.
PPE for operatives.
Air monitoring procedures.
Accident emergence procedures.
Probably duration of work.
Location of decontamination unit.

Inspection before Work Commences

The Competent Person should inspect the works to ensure that the control
measures are in place and invite a Union, or Staff Representative to be present, if
considered to be necessary.

Completion of Work

Before the enclosures are dismantled the contractor must arrange for Assurance
Monitoring within the enclosure, undertaken by a University approved Laboratory.
Usually the order to the Laboratory will be raised by the University, with
responsibility for arranging the time and place for the test left with the
contractor to organise.

The laboratory must be satisfied that the asbestos fibre count does not exceed
limits (0.01 fibres/ml).

Page 13
Appendicies

Appendix 1 – Permit to Work Form – PW01

High and Low Voltage Enclosures
Appendix 2 – Permit to Work Form – PW02
Hot Works Permit
Appendix 3 – Permit to Work Form – PW03
Roof Access Permit
Appendix 4 – Permit to Work Form – PW04
Plantroom Work Permit
Appendix 5 – Permit to Work Form – PW05
Category 3 Laboratory
Appendix 6 – Permit to Work Form – PW06
Confined Spaces Work Permit
Appendix 7 – Permit to Work Form – PW07
Asbestos Invasive Work Permit

Page 14
 ESTATES & FACILITIES MANAGEMENT DIVISION
Fielding Johnson Building, University Road, Leicester LE1 7RH, UK
T +44 (0)116 252 2522 F +44(0)116 223 1333

Permit to Work Form – PW01

High & Low Voltage Enclosures
This „Permit to Work‟ allows job specific entry to the University‟s high voltage sub-stations to undertake
works as detailed on the Form.

The areas covered by this permit are accessed by a secure key issued by the Estates and Facilities
Management Division authorised personnel named below:

Mr Stephen Rees – Head of Maintenance

Mr Bill Brookes – Electrical Services Maintenance Manager

This permit ceases to be in operation when the works detailed are complete and any keys issued have
been returned to the above names personnel.

Sub-stations are generally divided into three sections:

1. High Voltage Switchroom.

2. Low Voltage Switchroom.
3. Transformer enclosure – normally located within HC switchroom

When entering any of the sections, the following procedures shall be observed:

1. Before entering:

a. Let someone know you are going into a switchroom and when you are likely to return.
b. If you are unsure about any aspect of the job, STOP and seek further advice.

2. As you enter:

a. Check emergency exit doors are accessible and operable

b. Listen for hissing sounds, if you hear any do not enter
c. Smell for burning, if you smell burning do not enter

3. While inside:

a. Do not touch any electrical equipment

b. Do not operate any switches except light switches and power sockets
c. Do not leave sub-stations open or unattended
d. Ladders, steps or scaffolds required for use should be non-conductive and suitable for
electrical use
e. No eating or drinking is allowed in the sub-stations
f. If you hear hissing sounds – get out
g. If you smell any burning smells – get out
h. Any liquid spills shall be cleaned up immediately

4. As you leave

a. Clean up
b. Lock up
c. Return permit and keys to EFMD

5. IN CASE OF EMERGENCIES CONTACT SECURITY ON 0116 2522023 OR MAINTENANCE ON 0116

2522319
 ESTATES & FACILITIES MANAGEMENT DIVISION
Fielding Johnson Building, University Road, Leicester LE1 7RH, UK
T +44 (0)116 252 2522 F +44(0)116 223 1333

Permit to Work Form – PW01

High & Low Voltage Enclosures
SECTION A

Permission is granted to the person(s) named below to enter high voltage sub-stations in the
location(s) indicated and for the purposes given:

Name: Company:

Location:

Description of Work
to be Undertaken:

Date: Time: From to

Limits of the Permit:

Precautions to be taken:

SECTION B
Declaration: The dangers associated with working in or near to High Voltage
electrical systems have been explained to me and are fully
understood.

Name Signature

Company Date

SECTION C

Authorised by: Signature

Job Title: Date

 ESTATES & FACILITIES MANAGEMENT DIVISION
Fielding Johnson Building, University Road, Leicester LE1 7RH, UK
T +44 (0)116 252 2522 F +44(0)116 223 1333

Permit to Work Form – PW02

Hot Works Permit
SECTION A
Permission is granted to: Company:

To use:

At: Location:

Date: To Time: From To

SECTION B YES NO
Please tick as appropriate.
The above location has been examined………………………………………………………………
Are there combustible liquids, vapours, gases or dusts? ……………………………………
Suitable fire fighting equipment is available………………………………………………………
All combustible material has either been removed or suitably …………………………
protected against sparks.
Contractor aware of Fire Procedures (Section 16 – University of ………………………
Leicester Contractors General Code of Safe Practice)
Management arrangements to be implemented during and immediately after work:

SECTION C
Permit issued by: Signature:
Position: Date:

SECTION D
The work area and any adjacent areas where sparks or heat might have spread have been inspected on
completion of the work. An additional safety check of the area has been carried out at least one hour after
the work was finished.

Signature of person responsible for the work:

(after signing, return the permit to the person who issued it)

Notes
a) This Permit is applicable to all operations involving the application of flame, welding, burning,
brazing, and cutting equipment; bitumen or other mastic heaters and any other heat producing
operations involving the risk of fire.
b) This Permit applies to the works specified in Section A only.
c) Smoke/Heat detectors local to the work must be isolated before works begin and re-instated on
completion. (Fire alarm isolation Request Form MF02)

IN THE EVENT OF A FIRE, VACATE THE AREA, OPERATE THE NEAREST FIRE ALARM BREAK GLASS THEN
CONTACT SECURITY ON 0116 252 2023.
 ESTATES & FACILITIES MANAGEMENT DIVISION
Fielding Johnson Building, University Road, Leicester LE1 7RH, UK
T +44 (0)116 252 2522 F +44(0)116 223 1333

Permit to Work Form – PW03

Roof Access/Work Permit
SECTION A
Permission is granted to: Company:
To work on roof to carry out:

At (exact location):

Date: Time: From To

SECTION B YES NO
Please tick as appropriate.
The above location has been examined………………………………………………………………
Is the roof edge protected?.…………………………………………………………………………………
Suitable fall prevention equipment available and up to date test
certificates inspected……………………………………………………………………………………………
Two operatives to do the task………………………………………………………………………………
Are operative trained to use fall arrest equipment? ……………………………………………
Contractor aware of Contractors General Code of Safe Practice Procedures………
(Section 9 – Work above ground).
Is roof fragile, are crawl boards available.

SECTION C
Permit issued by: Signature:

Position: Date:

SECTION D
The dangers associated with working on roofs, especially those with no edge protection have been explained
to
me and are fully understood.
Name Signature

Company Date

Notes

a) This Permit is applicable for all operations at roof level.

b) Permits are job specific and are only valid for the works specified in Section A.
c) IN THE EVENT OF AN EMERGENCY CONTACT SECURITY IN 0116 252 2023 OR MAINTENANCE ON
0116 252 2319.
 ESTATES & FACILITIES MANAGEMENT DIVISION
Fielding Johnson Building, University Road, Leicester LE1 7RH, UK
T +44 (0)116 252 2522 F +44(0)116 223 1333

Permit to Work Form – PW04

Plantroom Work Permit

This „Permit to Work‟ allows job specific entry to plantrooms service ducts and other
service areas to undertake the works as detailed on the Permit.

The areas covered by this permit are under the control of the Estates and Facilities
Management Division Maintenance Section and no works can commence until a permit has
been issued by one of the following authorised persons:

Mr Steve Rees – Head of Maintenance

Mr Bill Brookes – Electrical Service Maintenance Manager
Mr Steve Bishop – Mechanical Service Maintenance Manager
Mr Darren Hughes – Controls Manager
Mr James Ruddle – Buildings Maintenance Manager

This permit ceases to be in operation when the works detailed are complete and the
plantroom has been returned to the control of the Maintenance Section and accepted by
the person issuing the permit.

The Contractor taking control of the plantrooms agrees to take responsibility for returning
it to the Maintenance Section in a clean and tidy condition which includes removal of all
rubbish and waste, completion of all thermal insulation, except that missing and agreed at
handover.

The Contractor agrees that unrestricted access to the plantroom will be made available to
Maintenance Staff to enable routine maintenance and service to equipment not forming
part of the Contractor‟s works.

The following procedure should be observed when issuing the Permit:

Inspect plantroom jointly with Contractor and Project Manager and agree
conditions of plantroom. Take photographs if necessary.
Arrange for plantroom to be cleared if not in a clean and tidy condition.
Re-inspect plantroom and agree condition with Contractor
Issue Permit.
On completion of the works inspect plantroom with Contractor and Project
Manager. Agree further work by contractor if plantroom is not acceptable or
Sign Permit, as works complete, accept plantroom and return completed permit
to Head of Maintenance for record purposes.
 ESTATES & FACILITIES MANAGEMENT DIVISION
Fielding Johnson Building, University Road, Leicester LE1 7RH, UK
T +44 (0)116 252 2522 F +44(0)116 223 1333

Permit to Work Form – PW04

Plantroom Work Permit
SECTION A
Permission is granted to the person(s) named below to undertake works in the plantroom(s)
indicated:
Name: Company:
Building: Location:
Description of Works to be undertaken:

Date: From To
Time: From To

SECTION B
The plantroom(s) has been jointly inspected and when handed to the person named in
Section A the following items were evident:

Permit issued by: Signature:

Position: Date:

SECTION C
I accept control of the plantroom and agree to return it in a clean and tidy condition
subject to
the items detailed in section B
Name: Signature:
Company: Date:

SECTION D

Return of the Plantroom to the Maintenance Section has been accepted by the undersigned
on the date indicated:

Name: Signature:

Date:
 ESTATES & FACILITIES MANAGEMENT DIVISION
Fielding Johnson Building, University Road, Leicester LE1 7RH, UK
T +44 (0)116 252 2522 F +44(0)116 223 1333

Permit to Work Form – PW05

Category 3 Laboratory
PART A (to be completed by the Estates Office)
Permission is granted to:
Room No. &
Location (exact):

Precise description of
work to be undertaken:

Duration of Permit

From: Date/Time: ……/……/…… am/pm

To: Date/Time: ……/……/…… am/pm

PART B (to be completed by the Estates Office)

Hazard Identification
Infection hazard: group 3 biological hazards are used in this laboratory.
No other special hazards are present.

Precautions
Biohazards have been secured within the containment level 3 labs.
If the permit and the site rules are adhered to, then the ricks from the above hazards are
negligible. No other specific precautions are needed.

Site Rules
(C3SM: Containment Level 3 Suite Manager)
You must contact C3SM (Containment Level 3 Suite Manager) or appointed person
before attempting to gain access.
Report to the C3SM, or the appointed person on arrival and departure.
Sign in as required by the C3SM when you arrive and depart site.
No eating, drinking or smoking is permitted in the laboratories.
Do not move ANY piece of equipment in the labs – contact the C3SM or a member of
the lab staff if you need anything to be moved.
Do not unplug or otherwise disconnect any other service to any lab equipment –
contact the C3SM or a member of the lab staff if your need anything to be
disconnected.
Do not open the doors of any lab equipment or lab furniture – this includes cupboards,
fridges, freezers and incubators.
 Do not enter any lab other than the one in which you are working and which this
permit covers.
Report all incidents immediately to the C3SM or his nominated deputy.
Inform the C3SM or appointed person when (1) leaving site temporarily, (2) finishing
work for the day (3) completing the job.
In some situations direct supervision is required – this means that a member of the lab
staff will accompany you in the lab until you have finished the job.
Any alteration, or work additional to the original job description, must e authorized by
appointed personnel.
The contractor must liaise with the C3SM or the appointed person to complete the C3
maintenance book detailing the work carried out.

YES NO
Contractor has been handed a copy of the University‟s latest
edition of Contractors General Code of Safe Practice:

Signature of authorising person (Estates): Date:

Name: Position:

Signature of C3SM or Appointed Person: Date:

Name: Position:

PART C (to be completed by Contractor)

In addition to isolation and procedures in Parts A and B, the following safety precautions
will be taken:
Acceptance

I have read and understood this Permit and will undertake to work in accordance with the
conditions set out herein and the University “Contractors General Code of Safe Practice”.

Method statement attached: YES/NO (delete as applicable)

Name of person in charge of work:

Company:

Signature: Time: Date:

Authorised/accepted permit to be returned to the Estates Office and copied to the C3SM
BEFORE commencement of the work. Master copy to be retained by Estates.

PART D (to be completed by Contractor)

Handback
YES NO
The work has been completed…………………………………………………………

Renewal of Permit required………………………………………………………………

All personnel under my supervision have been withdrawn………………

All materials and equipment have been withdrawn…………………………

Signature of person in charge of work: Date:

Form to be returned to authorising person. See Part B

PART E (to be complete by the Estates Office)

The work has been completed and equipment/area satisfactorily recommissioned.

Signature of authorising person (Estates): Date:

Name: Position:

Signature of C3SM or Appointed Person: Date:

Name: Position:

Ref……………………………..

Valid until……………………..

Date……………………………
 ESTATES & FACILITIES MANAGEMENT DIVISION
Fielding Johnson Building, University Road, Leicester LE1 7RH, UK
T +44 (0)116 252 2522 F +44(0)116 223 1333

Permit to Work Form – PW06

Confined Spaces Work Permit
PART A (to be completed by the Estates Office)
Permission is granted to:
Room No. &
Location (exact):

Precise description of
work to be undertaken:

Time/Date: ……/……/.….. Between am/pm and am/pm

PART B (to be completed by Estates & Buildings)

The above plant has been withdrawn from service at hours

on date and the atmosphere tested.

The above location has been isolated from: YES NO

Ingress of dangerous fumes and gases……………………………………………………

Sources of electrical power (locked off)…………………………………………………

Gas or liquids under pressure…………………………………………………………………

Steam or heat…………………………………………………………………………………………

The atmosphere has been tested for

The atmosphere has been found to be satisfactory for work to be carried

out with/without the use of breathing apparatus but continuous monitoring
is to be carried out whilst work is in progress…………………………………………………

Contractor has been handed a copy of the University‟s latest edition of

Contractor‟s General Code of Safe Practice………………………………………………………

Signature of person responsible for the work (Estates):

Position: Date:
PART C (to be completed by Contractor)

In addition to isolation and procedures in Parts A and B, the following

safety precautions will be taken: YES NO

Breathing apparatus…………………………………………………………………………………

Lifebelt/lifting equipment held on the outside of the confined space…

Eye protection…………………………………………………………………………………………

PPE (including protective clothing) ………………………………………………………

Dust respirator…………………………………………………………………………………………

Non-sparking approved tools…………………………………………………………………

Exhaust fan……………………………………………………………………………………………

The Contractor is to submit a method statement, stating a safe system

of work before proceeding on site, all in accordance with the Confined
Spaces Regulations 1997 and Approved Code of Practice………………………

I have read and understood this Permit and will undertake to work in accordance with the
conditions set out herein.

Name of person in charge of work:

Company:

Signature: Time: Date:

PART D (to be completed by Contractor)

Expiry of Permit
The work HAS/HAS NOT* been completed and all personnel under my supervision HAVE/HAVE
NOT* been withdrawn.

All materials and equipment HAVE/HAVE NOT* been withdrawn.

(*delete as appropriate)

Signature of person in charge of work: Date:

(Copy of this completed form to be handed to Estates & Buildings Office)

 ESTATES & FACILITIES MANAGEMENT DIVISION
Fielding Johnson Building, University Road, Leicester LE1 7RH, UK
T +44 (0)116 252 2522 F +44(0)116 223 1333

Permit to Work Form – PW07

Asbestos/Invasive Work

LOCATION OF WORK WITHIN THE PREMISES:

BRIEF DESCRIPTION OF WORK:

CLIENT/DUTY HOLDER:

Signature:

Please Print:

Date:

Will the work disturb any Asbestos containing materials (ACMs) identified in the premises
Asbestos Register?
http://leicester.ac.micadipr.net/idr-data/lite/asbestos.html

YES The proposed work MUST NOT proceed. Advice must be sought from:

Telephone: Estates & Facilities Management Division 0116 252 5036

Jess Woodall (COMPLIANCE MANAGER)

NO The proposed work can commence BUT the contractor needs to be

aware that there may be additional items of ACM’s in the
building/proposed work area over and above those identified in the
Asbestos Survey. The contractor’s attention is drawn to those places not
specifically accessed be the surveyor for the purpose of producing the
Asbestos Survey (e.g. Pipe ducts, wall voids).

WORK MUST STOP IMMEDIATELY IF ANY SUSPICIOUS MATERIALS ARE

DISCOVERED AND RESPONSIBLE PERSONS NOTIFIED.
CONTRACTOR:
I have read and understand the restrictions imposed by the permit to work.

Signature:

Please print: Company:

Date:

1 copy to be retained by Client/Duty Holder

1 copy to be retained by Contractor