Permit-to-work request form

reference brazil Updated Sep 10, 2026 1 min read hs-permit-to-work-form.md

Description of the form to request a permit to work.

Field	Description
Type	The type of permit.
Short description	Description of the permit.
Urgency	Option used to select the urgency of the permit request.
Risk assessment	The risk assessment associated with the request if any.
Risk before controls	Auto-populated when a risk assessment is selected.
Risk after controls	Auto-populated when a risk assessment is selected.
JSA	The job safety analysis ( JSA) on the site that is associated with the request if any.
Safety register	Any safety register relevant to the request.
Inspection	Option to add an inspection with the permit if needed.
Work task	The Health and Safety record relevant to the request.
Location	The location of the job.
Work area	The work area at the location.
Start date and time	The shift start date and time.
End date and time	The shift end date and time.
Approvals due by	The permit approval date.
Watch list	The individuals to notify about the status of the request.
Requested for	The Individuals the permit is requested for.
Description	Description of the permit.
Comments	Optional comments.
Attachment	Option to add attachments related to this permit.

Parent Topic:Health and Safety Risk Management reference

44 lines · 2.0 KB Wrap lines

---
title: Permit-to-work request form
description: Description of the form to request a permit to work.
locale: en-US
canonical_url: https://www.servicenow.com/docs/r/employee-service-management/health-and-safety-risk-management/hs-permit-to-work-form.html
release: brazil
product: Health and Safety Risk Management
classification: health-and-safety-risk-management
topic_type: reference
last_updated: "2026-09-10"
reading_time_minutes: 1
breadcrumb: [Reference, Health and Safety Risk Management, Health and Safety, Employee Service Management]
---

# Permit-to-work request form

Description of the form to request a permit to work.

|Field|Description|
|-----|-----------|
|Type|The type of permit.|
|Short description|Description of the permit.|
|Urgency|Option used to select the urgency of the permit request.|
|Risk assessment|The risk assessment associated with the request if any.|
|Risk before controls|Auto-populated when a risk assessment is selected.|
|Risk after controls|Auto-populated when a risk assessment is selected.|
|JSA|The job safety analysis \( JSA\) on the site that is associated with the request if any.|
|Safety register|Any safety register relevant to the request.|
|Inspection|Option to add an inspection with the permit if needed.|
|Work task|The Health and Safety record relevant to the request.|
|Location|The location of the job.|
|Work area|The work area at the location.|
|Start date and time|The shift start date and time.|
|End date and time|The shift end date and time.|
|Approvals due by|The permit approval date.|
|Watch list|The individuals to notify about the status of the request.|
|Requested for|The Individuals the permit is requested for.|
|Description|Description of the permit.|
|Comments|Optional comments.|
|Attachment|Option to add attachments related to this permit.|

**Parent Topic:**[Health and Safety Risk Management reference](https://raw.githubusercontent.com/ServiceNow/ServiceNowDocs/brazil/markdown/employee-service-management/health-and-safety-risk-management/hs-risk-mgmt-reference.md)