Scheme of Work for Entry by Contractors and Maintenance Staff Into Laboratories, Workshops

Permission to Access a Hazardous Area for the purposes of carrying out Maintenance Work

Section A to be completed by Requestor or Building Manager, (See Permission Request form for full details)
Description of work / Date of activity
Room / Space affected / Requestor
Section B (to be completed by the Space Owner / Person with responsibility for area or nominated deputy)
Nature of hazard(s) present / Check / Action Required
Biological agents
Hazardous / Explosive Chemicals
Radioactive Materials
Strong Magnetic Fields (e.g. NMR) or other significant EMF’s
Compressed Gases or Cryogens (e.g. liquid nitrogen)
Lasers or other non-ionising radiation inc. Optical radiation
Other (specify)
Name: / Position:
Signature: / Date: / Time:
Section C:Permission issued by Space Owner or Deputy (to be completed on the day of the work)
Measures taken to enable safe entry and work in the area(s)
LEV / MSC’s (inc. extracted cylinder cabinets)must not be isolated, control measures in place / LEV / MSC’s etc. are safe to be isolated
Work surfaces decontaminated / Equipment decontaminated (Certificate attached)
Reactions stopped / Chemicals/Solvents stored safely or removed
Area made safe – Remove; isolate; protect; Equipment; Substances; Materials
Specific instructions to be followed to ensure the safety of the Maintenance Operative(s) as part of Induction
Contractor not to move any laboratory items / Appropriate PPE agreed and provided
End Users notified / Report Incidents e.g. spills, unsafe work
Area Restrictions/signage in place / Correct disposal of waste
Remove PPE and wash hands thoroughly on exit / Other local rules (e.g. no food/drink, alarms etc) Details below
The area and/or item(s) to be worked on has had the actions in Section B completed, and is safe for work to commence.
Name: / Position:
Signature: / Date: / Time:
Permission received by Competent Maintenance Operative. I confirm that I will follow the local rules and that I have a full full
Understanding of the work involved, the hazardsand precautions required. Information has been explained to all persons involved.
Name: / Department/company:
Signature: / Date: / Time:
Section D (to be completed when the work is finished)
The work identified in this document has been completed, all tools and materials have been removed, and the area is left in a safe condition(permitting normal work to resume).
Work Completion (Maintenance Operative) / Name:
Signature: / Date: / Time:
Handover Acceptance (Space owner or nominated person) / Name:
Signature: / Date: / Time:

V1.1 June16