Checklist · Site Safety & Administration
Permit to Work
Formal authorisation for high-risk work activities including hot work, confined space entry, electrical isolation, and work at heights, per WHS Regulation.
33 checklist items · Last reviewed
Checklist Items
| Item | Pass / Yes | Fail / No |
|---|---|---|
| PERMIT INFORMATION | ||
| Permit Number | ||
| Site / Project Name | ||
| Date of Issue | ||
| Valid From (Time) | ||
| Valid Until (Time) | ||
| Work Location / Area | ||
| WORK TYPE | ||
| Hot Work (welding, grinding, cutting) | Yes | No |
| Confined Space Entry | Yes | No |
| Electrical Isolation / Live Work | Yes | No |
| Work at Heights (>2m) | Yes | No |
| Excavation / Trenching | Yes | No |
| Hazardous Substance Work | Yes | No |
| Other (describe) | ||
| WORK DESCRIPTION | ||
| Description of Work to be Performed | ||
| Equipment / Tools to be Used | ||
| Persons Performing the Work | ||
| PRE-WORK CHECKS | ||
| SWMS / JSA prepared and reviewed by workers | Yes | No |
| Hazardous area isolated (LOTO applied where required) | Pass | Fail |
| Atmosphere tested (for confined space / hot work) | Pass | Fail |
| Fire extinguisher / suppression equipment in place | Pass | Fail |
| PPE identified and available | Pass | Fail |
| Communication method agreed | Yes | No |
| Rescue plan in place (confined space / heights) | Yes | No |
| Adjacent workers / public notified | Yes | No |
| APPROVALS | ||
| Issuing Authority Name | ||
| Issuing Authority Signature | ||
| Permit Receiver / Worker-in-Charge Name | ||
| Permit Receiver Signature | ||
| PERMIT CLOSE-OUT | ||
| Work completed satisfactorily? | Yes | No |
| Area left safe and clean? | Yes | No |
| Isolations removed / services reinstated? | Yes | No |
| Permit Close-Out Date | ||
| Closing Authority Signature | ||