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Permit to Work Form Checklist

Permit to Work Form Checklist

This internal audit checklist template can be used to verify that the management of work permits works at an operational level.

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Permit to Work Form Checklist

This internal audit checklist template can be used to verify that the management of work permits works at an operational level.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

A permit to work is a legal document that gives your company permission to start a task that’s physically dangerous to workers, will potentially disrupt other business sectors, or addresses ecological concerns that the job might raise. An example of this is obtaining stormwater permits, which aim to prevent pollution to nearby bodies of water. The following template will cover the required documentation and e-permits as well as common problems people may encounter during the submission process.

Ensuring Safety and Compliance with a Permit to Work Form Checklist

A permit to work form is a document that gives companies permission to start a task that could be physically dangerous to workers, potentially disrupt other business sectors, or raise ecological concerns. To ensure safety and compliance, companies should use a permit to work form checklist.

The checklist should include critical details such as the task being performed, the location, the expected duration, and the potential hazards associated with the task. It should also require documentation of training and competence of the workers performing the task and any equipment to be used.

The permit-to-work form checklist should also include an assessment of potential risks and mitigation measures, such as personal protective equipment, emergency response plans, and environmental protection measures. Additionally, it should outline the communication protocols and any work restrictions or requirements.

By using a permit to work form checklist, companies can ensure that all necessary safety and compliance requirements are met before starting a task. This helps to reduce the risk of injury, prevent environmental damage, and ensure that the job is completed safely and effectively.

Related categories

Preview of the template
Audit
Permit to Work
Objective - It is the objective of this audit to determine that the permit management process is being delivered at an operational level. Measured outcome will be distribution and completion of associated documentation in the correct sequence, in the right location and to an acceptable quality. Closure of works must be regarded with the same sense of priority. All documentation must be assessed for completeness and accuracy.
Select a percentage of the open permits in circulation on the day of the visit. In the instance that there are none conduct a completed permit audit based on information attained and recorded from some previously recorded completions
1. Documentation
Does the work effort package contain the following documents:
a) access permit
b) associated high risk permit
c) critical works release form
d) COSHH data sheets
e) RAMS
f) Work Closure Form
g) any relevant drawings or manufacturers literature
2. E-Permit
a) has a permit been raised and approved in e-permit
b) have the correct high risk activities been considered, do they match those considered in the vendors risk assessment
c) does the permit reflect adequately the zone, location, service and activity associated with the works to be undertaken
d) has the permit been raised and closed within the system
3. Permit Issue
a) has the permit been issued at the place of work and the vendor retained a copy for display if requested
b) has the permit issuer signed the issued section
c) has the recipient (CP) signed the acceptance section, is the CP same as that printed on the permit
d). Is there a duplicate copy retained in the NOC
e) has the permit been issued on the system once the paper permit has been issued ( see section 2 (d) )
f) when questioned does the vendor display a thorough understanding of the works to be undertaken, the residual risks present and the control measures required to prevent risk. Has this been communicated to additional members of the team.
g) have all related documents been issued at the point of work
h) has the attendance attachment sheet been completed and signed by all attending contractors associated with the work effort
4. Permit Closure
a) has the recipient (CP) signed the clearance section, is the CP same as that printed on the permit
b) has the permit issuer signed the closure section at the point of work
c) has the permit been closed on the system once the paper permit has been issued ( see section 2 (d) )
5. Document Quality
a) access permit - are all sections completed satisfactorily
b) associated high risk permit - are all sections completed satisfactorily
c) critical works release form - are all sections completed satisfactorily
d) COSHH data sheets - are all sections completed satisfactorily
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This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.