Work Permit & Task Safety Assessment

• Location of works

• Conducted on

  Date

• Work Start Date

  Date

• Permit Expires

  Date

• Prepared by

• Description of work

• Unique Ref No (if available):

• Name of Team Leader

• Names of all team members (if any)

Site Protocols

• All members of the contractor team have signed in

  Yes

  No

  N/A

• All contractors are visibly wearing their pass?

  Yes

  No

  N/A

• Contractors made aware of toilet locations?

  Yes

  No

  N/A

• Contractors advised of fire exits?

  Yes

  No

  N/A

• Contractors advised of fire assembly point?

  Yes

  No

  N/A

• All contractors wearing safety shoes

  Yes

  No

  N/A

• Has product and work areas been protected against contamination and damage?

  Yes

  No

  N/A

• Contractor knows how to reach their site contact

  Yes

  No

  N/A

Permit Type

• Dynamic - urgent/routine works to be conducted under Trident generic RA and Supervision

  Yes

  No

  N/A

• If no, escalate to the Health & Safety Team to complete the remainder of the form

• Have the contractors been provided with a copy of PC1-7 - Safety Regulations for Contractors

  Yes

  No

  N/A

• Request a copy. Now received?

  Yes

  No

  N/A

• Is there a method statement covering the full scope of works?

  Yes

  No

  N/A

• Do the contractors have a copy with them?

  Yes

  No

  N/A

• Do we have a copy on file?

  Yes

  No

  N/A

• Is there a Risk Assessment covering the full scope of works?

  Yes

  No

  N/A

• Do the contractors have access to a copy?

  Yes

  No

  N/A

• Do we have a copy on file?

  Yes

  No

  N/A

• Do we have a copy of liability insurance certificates?

  Yes

  No

  N/A

• Is it possible to implement the controls proposed on the RAMs?

  Yes

  No

  N/A

• Designated walkways and emergency exits will be kept clear at all times unless working on them (then barriers must be deployed)

  Yes

  No

  N/A

• Has the work area been inspected prior to works?

  Yes

  No

  N/A

• Area clear of unexpected hazards or obstructions?

  Yes

  No

  N/A

• Can the hazards be removed or controlled adequately to allow the works to proceed?

  Yes

  No

  N/A

• Can additional and adequate controls be implemented?

  Yes

  No

  N/A

• Are works now safe to proceed?

  Safe

  At Risk

  N/A

• Door access card issued?

  Yes

  No

Personnel

• Contractors aware of accident reporting process?

  Yes

  No

  N/A

• Do any of the team have a medical condition which may affect them while on Trident premises?

  Yes

  No

• Are any of the contractors first aid trained?

  Yes

  No

• Do contractors know what action to take in the event of an accident?

  Yes

  No

  N/A

• Do the contractors have their own first aid supplies?

  Yes

  No

  N/A

• Does the contractor's First Aider know the location of our supplies?

  Yes

  No

  N/A

• Is their first aider aware of our accident reporting process?

  Yes

  No

  N/A

• Contractors aware of how to contact a first aider?

  Yes

  No

  N/A

• Are the team members qualified for the work to be undertaken?

  Yes

  No

  N/A

• How many contractors will be on site (maximum)

• How many Trident staff will be assisting?

• Does the team leader know how to reach his Trident contact?

  Yes

  No

  N/A

• Do all team members feel safe with the current controls?

  Yes

  No

  N/A

• If carrying out lifting activities, is the load within contractor's capabilities?

  Yes

  No

  N/A

Equipment

• All electrical equipment is PAT tested

  Yes

  No

  N/A

• Are any chemical substances to be used?

  Yes

  No

• Are Safety data Sheets available for all chemicals to be used?

  Yes

  No

  N/A

• Is the correct tooling and equipment available to carry out the work as per RAMS?

  Yes

  No

  N/A

• Is the equipment free from defects?

  Yes

  No

  N/A

• Is correct signage and/or barriers available?

  Yes

  No

  N/A

• Is the correct PPE available as stated in the RAMS?

  Yes

  No

  N/A

• Is any mechanical lifting to be used as part of the task?

  Yes

  No

• Is operator qualified?

  Yes

  No

  N/A

• Photo of qualification

  Media

• Has all equipment been inspected?

  Yes

  No

  N/A

• Harnesses will be worn

  Yes

  No

• Is any heavy lifting involved in this task?

  Yes

  No

• Are all staff involved in lifting trained in manual handling?

  Yes

  No

  N/A

Confined Spaces

• Does this task involve entry to confined spaces?

  Yes

  No

• Is this satisfactorily covered in the RAMS?

  Yes

  No

  N/A

Electrical

• Does this work involve working on or near electrical systems?

  Yes

  No

• Is this satisfactorily covered in the RAMS?

  Yes

  No

  N/A

• Can the power be isolated with a secondary isolation?

  Yes

  No

  N/A

• Can a safe isolation lock be applied?

  Yes

  No

  N/A

• How will the contractor guard against accidental switch on?

Hot Work

• Does the task involve any hot work?

  Yes

  No

• Has a hot work permit been issued?

  Yes

  No

  N/A

Working at Height

• Does this work involve working at height?

  Yes

  No

• Is this satisfactorily covered in the RAMS?

  Yes

  No

  N/A

• Have all ladders and/or other equipment been inspected?

  Yes

  No

  N/A

• Are ladders of fiberglass construction

  Yes

  No

  N/A

• Contractors provided with Fiberglass ladders

  Yes

  No

  N/A

• All ladders labelled as compliant to BS EN 131?

  Yes

  No

  N/A

Environmental

• Are contractors aware of the environmental impact reporting policy?

  Yes

  No

  N/A

• Are contractors aware of spill kit locations?

  Yes

  No

  N/A

• Will any of the activities produce high noise levels?

  Yes

  No

• Is this likely do disturb neighbours?

  Yes

  No

• Will works be complete by 18:00?

  Yes

  No

  N/A

• Has adequate provision been made to deal with any waste materials?

  Yes

  No

  N/A

• List expected waste streams?

• Any waste to be considered hazardous?

  Yes

  No

• Are adequate provisions in place to deal with hazardous waste (appropriate containers, safe storage areas).

  Yes

  No

  N/A

• Are current or expected weather conditions likely to increase the risk?

  Yes

  No

• Are safe working limits agreed (work will stop when limits reached)?

  Yes

  No

  N/A

• Details of anticipated risk:

• Is visibility, light level or ground condition likely to increase risk?

  Yes

  No

• Are other activities in the area likely to increase the risk?

  Yes

  No

• Details of anticipated risks:

• Are safe working limits agreed (work will stop when limits reached)?

  Yes

  No

  N/A

• Is mitigation in place to address this?

  Yes

  No

  N/A

Site Access Pass

• Pass card issued

  Yes

  No

• Access Level

  Exterior doors only

  Access all areas

• Justification for access all areas

• Acknowledge access cards will be returned to issuer

  Yes

  No

  N/A

• Understand that lost passes must be reported immediately

  Yes

  No

  N/A

Setup of working area

• Inspect work area(s) to assess for unexpected hazards or circumstances?

  Safe

  At Risk

  N/A

• Can the area be made safe prior to commencement of work?

  Yes

  No

  N/A

• Are additional precautions required?

  Yes

  No

• Appropriate warning signage displayed?

  Yes

  No

  N/A

• Barriers deployed?

  Yes

  No

  N/A

• Are Trident staff in the area aware of the work and potential hazards?

  Yes

  No

  N/A

Completion of Task

• Site contact will be briefed on progress prior to leaving

  Yes

  No

  N/A

• All work areas will be inspected at the end of each day to ensure tidy and free from hazards

  Yes

  No

  N/A

• Visitor ID to be returned to box in reception

  Yes

  No

  N/A

Permission To Start

• Contractor representative confirms that all information provided is accurate and that all team members under their control are aware that all work must be carried out in compliance with the RAMS and Trident site rules. Work will cease immediately if any changes occur which are not covered by the RAMS or this assessment and may not continue until a reassessment is made.

  Yes

  No

  N/A

• Name and signature of contractor team leader

  Sign

• Permission to work is granted with the defined controls.

  Yes

  No

  N/A

• Trident Representative name & signature

  Sign

• Contractor may now start job as planned. Complete finial section "Permit Closure" on completion of works.

Additional Information (optional)

• Feedback/Comments/Amendments?

Permit Closure

• Site contact briefed on progress prior to leaving site

  Yes

  No

  N/A

• Works completed as agreed to satisfactory standard

  Yes

  No

  N/A

• Door Access pass returned/cancelled

  Yes

  No

  N/A

• Work area left in safe condition

  Yes

  No

  N/A

• Comments:

• Date/time closed

  Date

• Work accepted and Permit closed by

  Sign

• Email copy of this report to contractor and self