Title Page

  • Conducted on

  • Prepared by

  • Location
  • Has the hole watch signed the permit?

  • Has the supervisor signed the permit?

  • Has the authorized permit issuer signed the permit?

  • Is the correct ventilation in place and running?

  • Does the permit reflect the work being done in the space?

  • Are the workers wearing appropriate PPE as per the permit?

  • If lock out is required are their personal locks in place?


  • Does the hole watch know what level the space is? (low/moderate)

  • Ask to see the hole watch log? Is it completed and accurate?

  • Does the hole watch know what work tasks the permit has been signed off for? (hot work, painting, cleaning, etc.)

  • Do the workers have the required training? (hole watch, entrant)


The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.