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General permit to work: complete before commencing any high-risk work activity
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Hazard Assessment
Mark the applicable column for each hazard: P = Present (controls required) | F = Fail (unacceptable, do not proceed) | N/A = Not applicable.
| # | Hazard | P | F | N/A | Notes / Controls |
|---|---|---|---|---|---|
| 1 | Working at heights | ||||
| 2 | Confined spaces | ||||
| 3 | Hot work (welding, cutting, grinding) | ||||
| 4 | Electrical hazards | ||||
| 5 | Excavation | ||||
| 6 | Hazardous substances | ||||
| 7 | Mobile plant / lifting | ||||
| 8 | Other: _______________ |
Precautions Checklist
Mark the applicable column: P = Pass | F = Fail | N/A = Not applicable. Do not issue permit if any critical item fails.
| # | Precaution | P | F | N/A | Notes / Action |
|---|---|---|---|---|---|
| 1 | Area isolated / barriered | ||||
| 2 | Lockout / tagout applied | ||||
| 3 | Gas testing completed | ||||
| 4 | Fire extinguisher available | ||||
| 5 | PPE identified and available | ||||
| 6 | Adjacent workers notified | ||||
| 7 | Signage displayed | ||||
| 8 | Emergency plan reviewed |
Declaration
I declare that all hazards have been assessed, all precautions are in place, and this permit has been authorised before work commenced. All personnel have been briefed on the hazards, controls and emergency procedures. The work area has been restored and all personnel accounted for at close-out.