Permit to Work Checklist

Use this Permit to Work Checklist to authorise and control high-risk contractor activities on site, covering hazard identification, isolation, PPE, and permit sign-off.

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Permit to Work Checklist



Work Details And Scope

1. The job description and scope of work are clearly defined and documented.


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2. The work location, including building, floor, and specific area, is recorded.


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3. The contractor or work party name and company are recorded.


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4. The permit issuer name and role are recorded.


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5. The tools, equipment, and materials to be used are listed.


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6. Any other work currently taking place in the area that may affect this permit is identified.


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7. The permit start date and time are recorded.


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8. The permit expiry date and time are recorded.


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9. The permit number or reference is assigned for tracking.


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Hazard Identification

1. A risk assessment or method statement for the work has been reviewed and is available on site.


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2. All hazards associated with the work have been identified and documented.


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3. Working at height hazards are identified and appropriate controls are in place.


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4. Confined space entry hazards are identified and a confined space permit is in place where required.


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5. Electrical hazards are identified and an electrical isolation permit is in place where required.


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6. Hot work hazards are identified and a hot work permit is in place where required.


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7. Chemical or hazardous substance hazards are identified and relevant SDS sheets are available.


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8. Mechanical hazards, including moving parts and pressurised systems, are identified and controlled.


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9. Manual handling hazards are identified and appropriate controls are in place.


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10. Environmental hazards, including spill risk and noise, are identified and controlled.


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11. Any additional hazards specific to the work area or task are identified and documented.


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Isolation And Control Measures

1. All energy sources requiring isolation (electrical, hydraulic, pneumatic, mechanical) are identified.


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2. Lockout/tagout procedures have been applied to all identified isolation points.


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3. Isolation points are verified as locked out and tagged before work commences.


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4. A record of all isolation points, including location and isolation method, is documented.


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5. Exclusion zones are established and clearly marked around the work area.


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6. Barriers, signage, and access controls are in place to prevent unauthorised entry.


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7. Conflicts with adjacent or simultaneous work activities have been identified and resolved.


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8. Fire protection systems affected by the work are identified and appropriate impairment permits are in place.


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9. Neighbouring personnel and departments affected by the work have been notified.


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PPE Requirements

1. Required PPE for the task is identified and documented on the permit.


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2. All members of the work party have access to and are wearing the required PPE.


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3. PPE is inspected and confirmed to be in good condition before work commences.


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4. Respiratory protection requirements are assessed and appropriate equipment is available where needed.


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5. Fall protection equipment is inspected and correctly fitted where working at height is involved.


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Emergency Arrangements

1. Emergency contact numbers, including site emergency coordinator, are communicated to the work party.


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2. The location of the nearest first aid kit and first aider on shift is confirmed and communicated.


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3. Evacuation routes and muster points are communicated to all members of the work party.


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4. Emergency shutdown procedures relevant to the work area are communicated.


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5. Rescue procedures are in place and communicated where confined space or working at height is involved.


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6. A fire extinguisher or appropriate firefighting equipment is accessible in the work area.


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Authorisation

1. The permit issuer confirms all hazards have been identified and controls are in place.


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2. The permit issuer confirms the work party has been briefed on all permit conditions.


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3. The permit issuer signs and dates the permit to authorise commencement of work.


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4. The contractor or permit receiver confirms they understand the scope, hazards, and controls.


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5. The contractor or permit receiver signs and dates the permit to accept its conditions.


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6. A copy of the signed permit is displayed at the work location for the duration of the work.


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7. Where work spans multiple shifts, the permit is revalidated and re-signed at each shift handover.


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Permit Closure

1. All work covered by the permit is confirmed as complete.


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2. Tools, equipment, and materials are removed from the work area.


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3. The work area is left in a clean and safe condition.


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4. All isolations are removed and energy sources are reinstated safely.


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5. Lockout/tagout devices are removed and their removal is documented.


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6. Any impaired fire protection systems are confirmed as restored to full service.


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7. The permit receiver confirms the work is complete and the area is safe.


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8. The permit issuer conducts a final check of the work area before closing the permit.


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9. The permit issuer signs off the permit closure and records the date and time.


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10. The completed permit is retained on file as a record of the authorised work.


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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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