Title Page
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Work Area
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Contractor
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Conducted on
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Prepared by
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Location
Part A
General Area - PPE, Housekeeping, HAZMAT, Fire Extinguishers
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PPE Boxes stocked? Storage areas for RPE clean and dust proof?
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PPE Signage in Place?
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Correct PPE for task and correctly worn?
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Housekeeping is good and free of trip hazards?
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Recycling in correct bins? All bins labelled correctly?
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Waste Stored Correctly?
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Hydrocarbon Bunds in place?
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HAZMATs stored in cabinets when not in use?
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Chemicals all stored correctly and labelled?
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SDS are nearby and available?
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Fire Cabinets - self closing and lock attached?
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Fire Extinguishers are the correct type and within date? And appropriately signed?
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Part B
Emergency Facilities & First Aid
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Emergency eye wash and shower signs fitted and visible?
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Are trauma kits available in work areas and LVs?
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All exits and access/egress to escape are kept clear and free of obstruction?
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Emergency Muster point clearly marked and known?
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Do operators have means of positive communication? Is the Emergency channel known?
Part C
Electrical
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All portable electrical items tagged with current electrical tag?<br>Dec-Feb = Red<br>Mar-May = Green<br>Jun-Aug = Blue<br>Sep-Nov = Yellow
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Leads, Plugs and sockets in good order?
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Leads off the ground and not exposed to water?
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ELCB/RCD used for portable tools?
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Part D
Hot Work
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Hazardous Areas identified correctly?
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Flashback arrestors on cylinders and hand pieces?
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Fire extinguishers available for all HW?
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Acetylene Bottles correctly stored/secured with frame lift point tagged/certified?
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Earth leads on Welders in good condition?
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All tools and equipment in good condition (no hard face, mushroom heads, splitting on drifts, loose or split heads or handles)?
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All 9" grinders have been removed?
Part E & F
Confined Spaces
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Signage - Do all entrances and hatches to confine spaces have appropriate signage? Is hot work in areas not currently defined as a CS now meet the definition?
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Conveyors (walk around plant)
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Rollers - do rollers have idler protection guards? Have guards been returned to plant appropriately?
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Warning Sirens - is the siren sounded to warn persons that the conveyor is starting?
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Signage - Are the correct signs in place ("restricted area" "danger conveyor starts automatically")?
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Signage - Are the signs clean and readable?
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Product - Is there any hang-up evident or visible?
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Part G
Scaffolding
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Scaffolds (tagged and less than 30 days old?)
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Are yellow self-closing gates present?
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Any dropped object hazards that could fall and cause injury?
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Excess scaffold equipment not removed from the area?
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Part H
Working at Heights & Dropped Objects
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Safety harness in good condition and correctly tagged?<br>Dec-Feb = Red<br>Mar-May = Green<br>Jun-Aug = Blue<br>Sep-Nov = Yellow
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Tool lanyards being used whilst working at height?
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Lanyard and Inertia reels in good condition and tagged?
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Dropped Objects - Are barriers in place and controls being used?
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Are materials stacked next to handrails creating the potential for dropped objects?
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Where floor panels/grid mesh have been removed, does the permit detail this? Are there barricades in place to manage falls? Has it been put back in place afterwards?
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Part I
Guards and Handrails
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Are there adequate handrails, guards or fences provided on all steps, stairs, elevated walkways, and platforms where there is a risk of falling?
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Are handrails in good condition, minimum height of 1200mm, with a mid rail and toe board?
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Ladders - Are ladders on elevated structural ladders enclosed?
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Are all moving parts on machinery that could cause a risk of injury screened or guarded to prevent contact?
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Part J & K
Crane Operations and Equipment
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Are Cranes and working zones correctly barricaded on the ground & the levels?
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Is the rigging gear in good condition and appropriately tagged?
Exclusion Zones
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Is exclusive control used to strictly control the group's work area?
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Exclusive control tape is not connected to any other tape?
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Is the single point of entry clearly defined?
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Is the JHA located at point of entry/exit and all relevant personnel signed on?
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Are information tags attached?
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Do the information tags contain the appropriate information and are legible?
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Is Danger tape being used correctly as NO GO areas that identify an area that contains a serious, major or catastrophic hazard?
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Is the caution tape used correctly to identify minor or medium level hazards?
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Part L
Isolations
Group Isolations
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Has everyone working the task placed their Red Lock on the Work Permit Board?
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Do all red locks have a Personal Danger tag attached?
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Personal Danger tags correctly filled out and legible?
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Have all in the work group signed the Permit Signature sheet?
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Is the isolation statement authorised and signed?
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Is there an associated Work Permit?
Simple Isolations
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Is each isolation point locked with a black lock and tag?
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Hasps are not daisy-chained?
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Have the work group placed their personal danger lock and tag on the hasp of the isolation point?
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Is the personal danger tag correctly filled in and legible?
