Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Is the Permit Authority registered as competent within the site's safe system of work system

  • Are isolating authorities registered as competent within the site's SSOW system

  • Is the task description full and clear on the Work Control Certificate

  • Has the correct location and area been identified on the Work Control Certificate

  • Have the required Electrical Isolation Confirmation Certificate(s) (ICC) and relating Work Control Certificate been cross referenced

  • Has the reason for the Electrical Isolation been fully defined on the Electrical Isolation Confirmation Certificate

  • Has a full description been given for each Electrical Isolation Point

  • Is a fully marked up and up to date drawing showing the location of each electrical isolation point available

  • Has each electrical isolation point been identified and correctly labelled

  • Is the quality of the Work Control Certificate risk assessment deemed adequate

  • Has a Toolbox Talk been carried out with the work party

  • Have all significant hazards and controls been identified and is the Work Control Certificate clear and concise

  • Is there an up to date copy of the Work Control Certificate at the worksite signed by all members of the work party

  • Is the work party aware of hazards from surrounding equipment and/or other work parties

  • Is the activity at the worksite within the boundaries specific in the task description of the Work Control Certificate

  • Have all the pre-requisite controls specified been put in place

  • Is the work party complying with all controls required by supporting certificates

  • Are any additional significant hazards, inadequate controls or changes in work scope identified after Work Control Certificate issue, been managed correctly

  • Have the controls required by the Work Control Certificate actually been put in place

  • Are supporting certificate requirements being managed correctly

  • Record details of any other issued/concerns regarding Control of Work revealed as a result of the self-verification review.

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