Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Is the Permit Authority registered as competent within the site's safe system of work system
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Are isolating authorities registered as competent within the site's SSOW system
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Is the task description full and clear on the Work Control Certificate
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Has the correct location and area been identified on the Work Control Certificate
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Have the required Electrical Isolation Confirmation Certificate(s) (ICC) and relating Work Control Certificate been cross referenced
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Has the reason for the Electrical Isolation been fully defined on the Electrical Isolation Confirmation Certificate
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Has a full description been given for each Electrical Isolation Point
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Is a fully marked up and up to date drawing showing the location of each electrical isolation point available
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Has each electrical isolation point been identified and correctly labelled
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Is the quality of the Work Control Certificate risk assessment deemed adequate
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Has a Toolbox Talk been carried out with the work party
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Have all significant hazards and controls been identified and is the Work Control Certificate clear and concise
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Is there an up to date copy of the Work Control Certificate at the worksite signed by all members of the work party
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Is the work party aware of hazards from surrounding equipment and/or other work parties
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Is the activity at the worksite within the boundaries specific in the task description of the Work Control Certificate
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Have all the pre-requisite controls specified been put in place
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Is the work party complying with all controls required by supporting certificates
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Are any additional significant hazards, inadequate controls or changes in work scope identified after Work Control Certificate issue, been managed correctly
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Have the controls required by the Work Control Certificate actually been put in place
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Are supporting certificate requirements being managed correctly
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Record details of any other issued/concerns regarding Control of Work revealed as a result of the self-verification review.