Permit to Work Application
Contractor Company Name.
Contractor Registration Number (if Known):
If you do not have a registration number, please complete Section A and send the form to the permit office:
permitstowork@kingston.ac.uk
To be completed by Permit Office
Date Received
Name of person checking Docs:
Permit number
Section A
Name of KU Responsible person / project manager
Department
Contact number
Date of request
Date work will start
Date work will finish
Contact name of main contractor
Contact Number
Contractors in work Group (inducted)
Contractor’s email
Location of work
Campus
Building
Room
Other (please detail)
If the contractor is registered complete section A and B and submit the form to: permitstowork@kingston.ac.uk
Section B
Scope of work
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Check the permit requirements below and ensure that the documents required are sent with the permit
application. If you have previously sent the information for this permit, mark the PTWM box.
Section C
Permit request checklist ALL WORK
Yes
No
PTWM*
Induction completed for all work group within last 12 months
KU contractor and Sub contractor policy signed.
Method Statement attached
Risk Assessment attached
Do all procedures comply with current relevant legislation
Is valid insurance held and copies supplied
Are all operatives suitably trained i.e. F-gas / Gas safe
Have training / accreditation records been supplied
Permit request checklist ISOLATIONS
Details of services isolated identified in method statement
Safe Isolation procedure detailed in Method Statement
Permit request checklist HAZARDOUS SUBSTANCES
COSHH Risk assessment attached
Material Safety Data sheet attached
Permit request checklist LABORATORIES
Supervision required by technician
Access arranged through university contact
Permit request Checklist WORK AT HEIGHT
If using harnesses , test certificates attached
Rescue procedure included RAMS
Permit request checklist CONFINED SPACE / EXCAVATION
Rescue/ safety watch procedure included in RAMS
Buried services / water sources checked
Permit request Checklist ASBESTOS
ASB5 Required
Copy of valid Asbestos Licence on file
Permit request HOT WORKS
Isolation / reinstatement of fire detection arranged
Hot works procedure and risk assessment included
Other Information
F10 Notification attached if required
Waste licences attached if required
Access to server rooms arranged with information services
KU Only: Property modification reference
(or reason why there is no reference)
PTWM* (Permit to Work Manager Database)
Documents submitted will be kept on file for 12 months and need not be resubmitted for each permit request
unless any details have changed in the last 12 months. Tick the PTWM box if you have previously submitted the
documents and you would like them included on this permit.
Please allow 24 hours for all permits to be issued once final documents have been submitted.
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