Section A - Completed in full especially the names of the Holder & Issuers & Risk Rating

Section B - Hazard Identification is complete and any JSA's are attached

Section C - Hazard Control Measures are appropriate for the task described

Section D - All other premits have been identified

Section E - Acceptance signed by the Holder

Section F - Holder acknowledges briefing of the Work Party

Section G - Working party briefed and all signed on

Section H - Area authority briefed and signed on

Section I - Transfer - Holder signed off and new holder signed on

Section J - Cancellation Completed by Permit Holder and Area Authority

Isolations match the working party in PTW and are correctly applied

Hot Work Permit complete and controls in place

Confined Space Permit complete and controls in place

Working at HeightsPermit complete and controls in place

OtherPermit complete and controls in place

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.