Name of employees:
Permit to Work
Confined Space Permit
JSEA been completed and signed for the job
All isolations and lock outs have been performed.
All safety aspects of the job are known and understood
Approved barricading, shade cloth and signage in place.
Relevant authority informed on arrival.
Evacuation procedures for the area are known and understood.
Correct PPE for the task is being worn and is in good condition.
Housekeeping in work area up to high standard.
Inspection of worksite carried out checking for hazards.
Hazards or safety concerns for the worksite are as follows:
Actions taken over any hazards or safety concerns:
Can I do this job safely?