Safe work Permit
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Published by SALUSSafe Work Permit Checklist
This checklist is designed to ensure that all necessary safety precautions are taken before and during work activities that require a safe work permit. It covers key areas to verify that the work environment is safe and that all personnel are aware of the hazards and control measures in place.
Instructions: Complete this checklist before starting any work that requires a safe work permit. Ensure all items are checked and any deficiencies are corrected before work begins. All personnel involved in the work must be familiar with this checklist.
I. Permit Information
- [ ] Permit Number:
- [ ] Date and Time of Issuance:
- [ ] Location of Work:
- [ ] Description of Work:
- [ ] Permit valid from (Date/Time): ____________ to (Date/Time): ____________ [1]
- [ ] Reason for entry: ____________ [2]
II. Hazard Assessment and Control
- [ ] Hazards identified and evaluated [1]:
- [ ] Atmospheric hazards (e.g., oxygen deficiency, toxic gases, flammable vapors) 4, 17
- [ ] Physical hazards (e.g., moving machinery, confined spaces, fall risks) 4, 7
- [ ] Other hazards:
- [ ] Measures to eliminate or control hazards implemented [1]:
- [ ] Isolation of energy sources (lockout/tagout) 1, 2
- [ ] Ventilation to maintain acceptable atmospheric conditions 4, 11
- [ ] Barriers and shields to protect from external hazards 4, 15
- [ ] Fall protection measures in place [3]
- [ ] Acceptable entry conditions verified 1, 2:
- [ ] Testing and monitoring equipment available and calibrated 4, 15
- [ ] Results of initial and periodic tests recorded 1, 2
III. Personal Protective Equipment (PPE)
- [ ] Required PPE available and in good condition 1, 4:
- [ ] Hard hat
- [ ] Safety glasses/goggles
- [ ] Gloves (specify type):
- [ ] Safety shoes
- [ ] Other (specify):
- [ ] PPE properly used by all personnel [3]
IV. Communication and Coordination
- [ ] Communication procedures established and understood by all entrants and attendants 1, 10, 14
- [ ] Emergency contact information readily available [2]
- [ ] Rescue and emergency services identified and available 1, 10
- [ ] Procedures for summoning rescue services established 1, 16
- [ ] Coordination with other employers (if applicable) 16, 20
V. Personnel and Training
- [ ] Authorized entrants listed on permit [2]
- [ ] Attendant(s) assigned and aware of duties 1, 13, 14
- [ ] Entry supervisor identified and aware of responsibilities 1, 9
- [ ] All personnel trained on hazards, entry procedures, and use of equipment 1, 3, 6, 8
- [ ] Training records available for inspection [5]
VI. Equipment
- [ ] All equipment required for the job is available, inspected, and in good working order 1, 4:
- [ ] Testing and monitoring equipment 4, 15
- [ ] Ventilating equipment 4, 15
- [ ] Communications equipment 4, 15
- [ ] Lighting equipment 4, 15
- [ ] Rescue equipment 4, 15
VII. Permit Sign-off
- [ ] All items on this checklist have been verified and completed.
- [ ] Work area is safe to proceed.
Entry Supervisor Name: ____________
Entry Supervisor Signature: ____________
Date: ____________
VIII. Cancellation of Permit
- [ ] Work completed.
- [ ] All personnel and equipment removed from the work area.
- [ ] Work area left in a safe condition.
- [ ] Permit cancelled.
Entry Supervisor Name: ____________
Entry Supervisor Signature: ____________
Date: ____________
IX. Additional Permits (if applicable)
- [ ] Hot Work Permit 1, 6, 19
- [ ] Hot work permit requirements implemented prior to beginning the hot work operations [6].
- [ ] Other permits (specify):
X. Notes/Comments:
- [ ] Any problems encountered during the entry [7]:
XI. Corrective Actions:
- [ ] Deficiencies identified:
- [ ] Corrective actions taken:
- [ ] Verified by:
- [ ] Date:
This checklist is a tool to assist in maintaining a safe work environment. It is not a substitute for proper training, experience, and judgment.
Sources used for this answer
[1] Occupational Safety and Health Standards (OSHA 29 CFR 1910)
Page 110
Open source documentSource excerpt
## 29 CFR 1910 (OSHA) - (2) Training shall be provided to each affected employee: - (i) Before the employee is first assigned duties under this section; - (ii) Before there is a change in assigned duties; - (iii) Whenever there is a change in permit space operations that presents a hazard about which an employee has not previously been trained; - (iv) Whenever the employer has reason to believe either that there are deviations from the permit space entry procedures required by paragraph (d)(3) of this section or that there are inadequacies in the employee's knowledge or use of these procedures. - (3) The training shall establish employee proficiency in the duties required by this section and shall introduce new or revised procedures, as necessary, for compliance with this section. - (4) The employer shall certify that the training required by paragraphs (g)(1) through (g)(3) of this section has been accomplished. The certification shall contain each employee's name, the signatures or initials of the trainers, and the dates of training. The certification shall be available for inspection by employees and their authorized representatives. - (h) Duties of authorized entrants. The employer shall ensure that all authorized entrants: - (1) Know the hazards that may be faced during entry, including information on the mode, signs or symptoms, and consequences of the exposure; - (2) Properly use equipment as required by paragraph (d)(4) of this section; - (3) Communicate with the attendant as necessary to enable the attendant to monitor entrant status and to enable the attendant to alert entrants of the need to evacuate the space as required by paragraph (i)(6) of this section; - (4) Alert the attendant whenever: - (i) The entrant recognizes any warning sign or symptom of exposure to a dangerous situation, or - (ii) The entrant detects a prohibited condition; and - (5) Exit from the permit space as quickly as possible whenever: - (i) An order to evacuate is given by the att…
[2] Rules for the Administration of the Oregon Safe Employment Act (General Occupational Safety and Health, Division 2, OSHA Oregon)
Page 929
Open source documentSource excerpt
J Division 2 Oregon Administrative Rules Oregon Occupational Safety and Health Division - (H) Names of entrants and current attendants. - (I) The signature of the original supervisor authorizing entry. - (J) The current entry supervisor. - (K) Communication procedures for entrants and attendants to maintain contact during the entry. - (L) Equipment provided for safe entry, such as: - (i) Personal protective equipment (PPE). - (ii) Testing and monitoring equipment. - (iii) Communications equipment. - (iv) Alarm systems. - (v) Rescue equipment. - (M) Rescue services available, and how to contact them. - (N) Other information needed for safety in the particular permit space. - (O) Additional permits issued for work in the space, such as for hot work. - (P) Any problems, if any, encountered during the entry. - (c) Perform initial testing for atmospheric hazards, where necessary, before entry is made. - (d) Provide each entrant or their authorized representative with the results of any initial testing before they enter the space. - (e) Maintain safe entry conditions for the duration of the entry. - (A) When the space is too large to isolate, or is part of a continuous system, such as a sewer, ensure continuous monitoring where entrants are working for the duration of the entry. - (B) When an entrant or their authorized representative has reason to believe that the testing or monitoring was inadequate, re-test the space. - (f) Follow all actions and precautions identified on the permit. - (g) When conditions require the space to be evacuated, do not allow re-entry unless you: - (A) Re-assess the conditions of the space to ensure it is safe for re-entry and ensure the permit reflects the evacuation and subsequent reassessment; or
[3] Rules for the Administration of the Oregon Safe Employment Act (General Occupational Safety and Health, Division 2, OSHA Oregon)
Page 928
Open source documentSource excerpt
Oregon Occupational Safety and Health Division Oregon Administrative Rules AO 1-2025 Division 2 - (v) An employee reports of concerns about the effectiveness of the program. - (vi) Any other condition that affects employee safety or health. - (B) When revising the permit program to correct hazard-related deficiencies, do not allow entries into affected permit spaces to be made until the revisions are complete. - (C) Provide employees and their representatives access to the revised permit program. - (g) Review permits within one year of their cancellation to evaluate: - (A) The permit program. - (B) The protection provided to employees entering permit spaces. - (6) Permit Entry. - (a) Develop and implement procedures for issuing permits. Procedures must include how to: - (A) Evaluate the hazards of the space. - (B) Evaluate hazards of the work to be performed. - (C) Identify safe entry conditions. - (b) Entry permits must include the following information: - (A) The space to be entered. - (B) The purpose of the entry. - (C) The date, start, and stop times of the permit. - (D) The hazards of the space. - (E) Acceptable entry conditions. - (F) Results of initial tests and periodic monitoring performed to evaluate and identify the hazards and conditions of the space, or the period for continuous monitoring, accompanied by the names or initials of the testers and by an indication of when the tests were performed. - (G) Appropriate measures used before entry to isolate the space and eliminate or control hazards. - Examples of appropriate measures include the de-energizing and lockout or tagging of equipment, and procedures for purging, inerting, ventilating, and flushing permit spaces.
[4] Occupational Safety and Health Standards (OSHA 29 CFR 1910)
Page 12
Open source documentSource excerpt
## 29 CFR 1910 (OSHA) - (2) The permit shall document that the fire prevention and protection requirements in 29 CFR 1910.252(a) have been implemented prior to beginning the hot work operations; it shall indicate the date(s) authorized for hot work; and identify the object on which hot work is to be performed. The permit shall be kept on file until completion of the hot work operations. - (l) Management of change. (1) The employer shall establish and implement written procedures to manage changes (except for 'replacements in kind') to process chemicals, technology, equipment, and procedures; and, changes to facilities that affect a covered process. - (2) The procedures shall assure that the following considerations are addressed prior to any change: - (i) The technical basis for the proposed change; - (ii) Impact of change on safety and health; - (iii) Modifications to operating procedures; - (iv) Necessary time period for the change; and, - (v) Authorization requirements for the proposed change. - (3) Employees involved in operating a process and maintenance and contract employees whose job tasks will be affected by a change in the process shall be informed of, and trained in, the change prior to start-up of the process or affected part of the process. - (4) If a change covered by this paragraph results in a change in the process safety information required by paragraph (d) of this section, such information shall be updated accordingly. - (5) If a change covered by this paragraph results in a change in the operating procedures or practices required by paragraph (f) of this section, such procedures or practices shall be updated accordingly. - (m) Incident investigation. (1) The employer shall investigate each incident which resulted in, or could reasonably have resulted in a catastrophic release of highly hazardous chemical in the workplace. - (2) An incident investigation shall be initiated as promptly as possible, but not later than 48 hours following the inciden…
[5] Occupational Safety and Health Standards (OSHA 29 CFR 1910)
Page 100
Open source documentSource excerpt
## 29 CFR 1910 (OSHA) Entry permit (permit) means the written or printed document that is provided by the employer to allow and control entry into a permit space and that contains the information specified in paragraph (f) of this section. Entry supervisor means the person (such as the employer, foreman, or crew chief) responsible for determining if acceptable entry conditions are present at a permit space where entry is planned, for authorizing entry and overseeing entry operations, and for terminating entry as required by this section. NOTE: An entry supervisor also may serve as an attendant or as an authorized entrant, as long as that person is trained and equipped as required by this section for each role he or she fills. Also, the duties of entry supervisor may be passed from one individual to another during the course of an entry operation. Hazardous atmosphere means an atmosphere that may expose employees to the risk of death, incapacitation, impairment of ability to self-rescue (that is, escape unaided from a permit space), injury, or acute illness from one or more of the following causes: - (1) Flammable gas, vapor, or mist in excess of 10 percent of its lower flammable limit (LFL); - (2) Airborne combustible dust at a concentration that meets or exceeds its LFL; NOTE: This concentration may be approximated as a condition in which the dust obscures vision at a distance of 5 feet (1.52 m) or less. - (3) Atmospheric oxygen concentration below 19.5 percent or above 23.5 percent; - (4) Atmospheric concentration of any substance for which a dose or a permissible exposure limit is published in subpart G, Occupational Health and Environmental Control, or in subpart Z, Toxic and Hazardous Substances, of this part and which could result in employee exposure in excess of its dose or permissible exposure limit; NOTE: An atmospheric concentration of any substance that is not capable of causing death, incapacitation, impairment of ability to self-rescue, injury,…
[6] Occupational Safety and Health Standards (OSHA 29 CFR 1910)
Page 106
Open source documentSource excerpt
## 29 CFR 1910 (OSHA) - (iv) Purging, inerting, flushing, or ventilating the permit space as necessary to eliminate or control atmospheric hazards; - (v) Providing pedestrian, vehicle, or other barriers as necessary to protect entrants from external hazards; and - (vi) Verifying that conditions in the permit space are acceptable for entry throughout the duration of an authorized entry. - (4) Provide the following equipment (specified in paragraphs (d)(4)(i) through (d)(4)(ix) of this section) at no cost to employees, maintain that equipment properly, and ensure that employees use that equipment properly: - (i) Testing and monitoring equipment needed to comply with paragraph (d)(5) of this section; - (ii) Ventilating equipment needed to obtain acceptable entry conditions; - (iii) Communications equipment necessary for compliance with paragraphs (h)(3) and (i)(5) of this section; - (iv) Personal protective equipment insofar as feasible engineering and work practice controls do not adequately protect employees; - (v) Lighting equipment needed to enable employees to see well enough to work safely and to exit the space quickly in an emergency; - (vi) Barriers and shields as required by paragraph (d)(3)(v) of this section. - (vii) Equipment, such as ladders, needed for safe ingress and egress by authorized entrants; - (viii) Rescue and emergency equipment needed to comply with paragraph (d)(9) of this section, except to the extent that the equipment is provided by rescue services; and - (ix) Any other equipment necessary for safe entry into and rescue from permit spaces. - (5) Evaluate permit space conditions as follows when entry operations are conducted: - (i) Test conditions in the permit space to determine if acceptable entry conditions exist before entry is authorized to begin, except that, if isolation of the space is infeasible because the space is large or is part of a continuous system (such as a sewer), pre-entry testing shall be performed to the extent feasibl…
[7] Occupational Safety and Health Standards (OSHA 29 CFR 1910)
Page 109
Open source documentSource excerpt
## 29 CFR 1910 (OSHA) - (1) The permit space to be entered; - (2) The purpose of the entry; - (3) The date and the authorized duration of the entry permit; - (4) The authorized entrants within the permit space, by name or by such other means (for example, through the use of rosters or tracking systems) as will enable the attendant to determine quickly and accurately, for the duration of the permit, which authorized entrants are inside the permit space; NOTE: This requirement may be met by inserting a reference on the entry permit as to the means used, such as a roster or tracking system, to keep track of the authorized entrants within the permit space. - (5) The personnel, by name, currently serving as attendants; - (6) The individual, by name, currently serving as entry supervisor, with a space for the signature or initials of the entry supervisor who originally authorized entry; - (7) The hazards of the permit space to be entered; - (8) The measures used to isolate the permit space and to eliminate or control permit space hazards before entry; - NOTE: Those measures can include the lockout or tagging of equipment and procedures for purging, inerting, ventilating, and flushing permit spaces. - (9) The acceptable entry conditions; - (10) The results of initial and periodic tests performed under paragraph (d)(5) of this section, accompanied by the names or initials of the testers and by an indication of when the tests were performed; - (11) The rescue and emergency services that can be summoned and the means (such as the equipment to use and the numbers to call) for summoning those services; - (12) The communication procedures used by authorized entrants and attendants to maintain contact during the entry; - (13) Equipment, such as personal protective equipment, testing equipment, communications equipment, alarm systems, and rescue equipment, to be provided for compliance with this section; - (14) Any other information whose inclusion is necessary, given the circu…
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