Permit to Work Systems Checklist - Aviva Loss Prevention Standards - Property V1.3

• Conducted on

  Date

• Prepared by

• Location
  Address

• To view our Loss Prevention Standard that supports this checklist, please view the following link : https://broker.aviva.co.uk/documents/view/aviva_permit_to_work_systems_lps.pdf

Permit to Work Systems

• 1. Is there a formal permit to work (PTW) procedure in place for all high-risk activities, stating the obligations of each party, and includes health and safety standards and property protection precautions?

  Yes

  No

  N/A

• 2. If hot work is to be completed, is the limit of public liability insurance adequate for the area they are working on and the possible exposure?

  Yes

  No

  N/A

• Are there any restrictions in their insurance policy on completing hot works?

  Yes

  No

  N/A

• 3. Have reasonable checks been completed to ensure that the persons undertaking the work, including contractor employees are competent?

  Yes

  No

  N/A

• 4. Has the task(s) to be undertaken been clearly defined on the PTW form?

  Yes

  No

  N/A

• For all contractor permit to work tasks, have copies of relevant risk assessments and method statements been requested and received from the contractor and are readily available to the permit issuer?

  Yes

  No

  N/A

• 6. Are control measures clearly defined on the PTW forms?

  Yes

  No

  N/A

• 7. Is suitable PPE available, provided and worn correctly by all employees and/or contractors undertaking tasks that require a PTW?

  Yes

  No

  N/A

• 8. Where testing is required, e.g. for working in confined spaces, has this been carried out and recorded?

  Yes

  No

  N/A

• 9. Are emergency procedures in place, e.g. confined spaces/work at height rescue plan?

  Yes

  No

  N/A

• 10. Are isolation and lock-off procedures being followed where appropriate?

  Yes

  No

  N/A

• 11. Regular supervision and monitoring is undertaken during the period the PTW is open?

  Yes

  No

  N/A

• 12. Are all PTW signed in all the 4 boxes by the authorised persons?

  Yes

  No

  N/A

• 13. The permit is not allowed to extend beyond a maximum of a single shift (maximum of 12 hours)?

  Yes

  No

  N/A

• 14. Are the standards recommended in the Aviva Loss Prevention Standard: Hot Work Operations followed?

  Yes

  No

  N/A

• 15. Have all combustible materials been moved away from the working area (minimum of 10m)?

  Yes

  No

  N/A

• 16. Has consideration been given to potential fire spread/combustible construction features/explosive atmospheres in the hot working area?

  Yes

  No

  N/A

• 17. Is there a continuous fire watch during the work; and an additional 60-minutes continuous monitoring immediately after completion of the work?

  Yes

  No

  N/A

• 18. Is there a further 180-minutes of intermittent fire watch checks undertaken where necessary (refer to risk assessment)?

  Yes

  No

  N/A

• 19. Appropriate fire extinguishers are provided?

  Yes

  No

  N/A

• 20. Is the PTW only issued for one shift?

  Yes

  No

  N/A

• 21. Are all items of equipment, hot waste materials, stub ends of welding rods removed and either stored securely or disposed of correctly?

  Yes

  No

  N/A

• 22. Are all incidents, near misses, injuries sustained, or damage caused reported and investigated thoroughly?

  Yes

  No

  N/A

Completion

• Comments

• Completed by: (Name and Signature)

  Sign