PERMIT TO WORK No.
SECTION 1 - PRIOR TO COMMENCING
Site Management Contractor induction Contractor JSEA/SWMS required for job covered by this permit provided and reviewed
Notified of Works completed and MSIC card insurances and by TASPORTS Competent person. (If not available, risk assessment must be
(incl. electrical work) displayed register up to date completed prior to task commencing)
CONTRACTORS Permit Entered in Permit to Work Log Site Orientation Provided
SECTION 2 - PERMIT TO WORK CERTIFICATE (ensure copy of active permit is kept at worksite where work is being carried out)
Site Name: Tick ü the CATEGORY of work(s) to be performed
Description of work For Tasks listed below In addition - For tasks listed below
to be performed: Complete Hazard ID Guide (Section 5) Complete Separate Permit
Person/Company
Responsible for work A - Non Routine Work
Excavation & Earth Works
Activity (Including Asbestos)
(Person in Charge)
B - Hot Work (work exceeding 8 hrs
Mobile Phone Number: or 2 hr break, complete daily hot Mobile Crane Work
work checklist)
Person/Company
Undertaking the Work: C - Working on Water /
Electrical Work
Under wharves
Mobile Phone Number:
List Equipment or
D - Cold Work Diving
Plant to be Worked on:
Exact Location of E - Work at Heights Confined Spaces
Equipment or Plant: (Including over the side of a wharf) (Refer to Confined Space Procedure)
SWP/SOP Ref No/s F - Landside Plant Refuel, Slipway / Abrasive Blasting
(copies must be attached) Maintenance & Lube Spray painting
JSEA/SWMS Ref No/s
G - Blind Penetration Isolation Permit
(copies must be attached)
Emergency Contact numbers 000 (Fire, Ambulance & Police) 1300 664 007 (Tasports’ Security)
LIST EQUIPMENT ISOLATED (Note all isolations to be
Signed by Signed by
carried out in accordance with Tasports Lock Out Tag Checked by
TASPORTS Person Non-TASPORTS Person
Out Procedure)
1.
2.
3.
SECTION 3 - AUTHORISATION
PERMIT ISSUER – I have discussed the work to be performed with the recipient, the hazards identified and the agreed methods of work. I authorise the work
specified to proceed, provided the precautions listed on this permit and attached documentation are observed.
Name: Signature: Date:
Permit Valid from (Date/Time): to (Date/Time):
PERMIT RECIPIENT Directly Managing Work - I have assessed and discussed the work to be performed with the permit issuer and agree to comply with all
agreed controls, site safety requirements and with all provisions of this permit, and to explain and enforce those provisions with all persons under my responsibility.
Recipient Name: Signature: Date:
SECTION 4 - PERMIT HANDOVER/PERMIT FINALISATION
Work not complete, handover completed Permit Handover: Signed Outgoing Permit Issuer: Dated:
Work complete, proceed to permit closure Signed Incoming Permit Issuer: Dated:
Completion of Works and Permit Closure – RECIPIENT Permit Closure – ISSUER
All work has been completed, people and equipment withdrawn from the plant/area, I am satisfied that all work associated with this Permit has been
isolations removed and the plant/area is clean and safe for use. completed in accordance with the Permit Conditions.
Hot Work - Work area and surroundings checked for spot fires from start of work and for 2
hours after completion and found safe.
Yes No If No, reason must be documented in the task risk assessment Name: Signed:
Fire watch Standby Person (Name): Signed: Date: Time:
Date:
Name: Signature: All Permit/s Closed Out in Permit to Work Log
Date: Time: All Permit/s filed in Trim when completed
Permit to Work | Version 4 | May 2022 Page 1 of 3
PERMIT TO WORK No.
SECTION 5 - HAZARD IDENTIFICATION GUIDE
Refer to each applicable reference below, you must document the risk control for each hazard identified. Yes ü No × or Not Applicable N/A
Ref # Type of work to be performed ü× N/A Ref # Type of work to be performed ü× N/A
A - Non Routine work (including asbestos): If oxyacetylene is being used is it fitted with flashback
B15
arrestors?
Will work involve working in a restricted area, ie AQIS,
A1 Workers told of nearest fire alarm/EWIS phone and
Landside Restricted Zone, Airside etc.? B16
emergency procedures?
Is the work modification of plant/equipment/building design? or
A2 B17 All equipment for hot work is in good repair and checked?
building of a temporary or permanent structure? (ensure meets
design standards - contact TasPorts Engineering Department)
Sprinklers, hydrants and extinguishers available during the
A3 Does the work have documented work instructions or procedures? B18 work and in service? (Fire extinguisher to be located within
Does the work require intermittent removal of isolations and 5m of work)
A4
test running of equipment? B19 Automatic fire detection system zone temporarily isolated?
Does the work involve wet cleaning or use of water around
A5 Welding Screens in place to prevent sparks moving beyond
electrical equipment? B20
the work area?
Will mains powered electrical equipment be used? If so,
Ducts and conveyors that may carry sparks to distant
A6 ensure you have adequate RCD protection for use with such B21
combustibles are isolated?
equipment and it is in current test & properly tagged
Will plant isolation be required in accordance with Tasports B22 Floors swept clean?
A7
“lock out tag out procedure”? B23 All wall and floor openings covered?
Have arrangements been made with the Contract Supervisor
A8 B24 Fire resistant tarpaulins beneath work?
for such plant isolation to be carried out?
Are you using hazardous chemicals or dangerous goods? B25 Explosive atmosphere in area eliminated?
A9 (You must have the relevant SDS (Safety Data Sheets)
available in case of emergency) B26 Person conducting hot work is competent to undertake task?
A10 Are there any manual handling risks involved? B27 Atmospheric testing is required?
Will the work be carried out near Asbestos material? Work area, trenches, pits etc. clear of flammable liquids,
A11 B28
If yes, refer to Tasports Asbestos Procedure. dust, gases, vapours and oily deposits removed?
A12 Will work be conducted near overhead power lines? Other combustibles removed where possible or are
B29
protected with fire resistant tarpaulins or metal sheets?
A13 Will the work involve overhead loads?
Work area and surroundings checked for spot fires from
Could there be potential for environmental contamination start of work and for 2hours after completion and found
A14
as a result of works being conducted? B30 safe? (this is mandatory requirement) If 2 hr fire
watch is deemed not required this must be fully
A15 Will work be conducted in a hazardous area?
documented in a risk assessment.
B - Hot Work:
B31 Will work be conducted in a hazardous area?
B1 Are weather conditions appropriate?
C - Working on Water / Under Wharves
Is there a Fire Ban in place? Visit Tas Fire Service Website
B2 Are all surfaces capable of supporting workers weight?
“bans and permits” or call Tas Fire head office (03) 6230 8600 C1
ie. Access equipment
B3 Is it impractical to conduct the work in the welding bay?
C2 Is there a communication system in place?
Is work on or near the expanded polystyrene insulated
B4 sandwich panel (EPS)? If yes, refer to G2. C3 Is there an adequate rescue plan in place?
(no hot work is to be conducted on (EPS)
Permit to Work | Version 5 | December 2021
Haveyou
Have youcontacted
notified Tasports VTS
TasPorts to works
priorYou
VTS? must commencing
contact VTS
Is dust in the area (Explosive atmosphere) likely to impact prior
and to works commencing
immediately after? and immediately after works
B5 C4
on works being undertaken? cease. Contact
You MUST should
contact be via VTS
TasPorts VHF(1300
Radio366
Channel 14 to
742) prior
(Northern Ports) Channel 12 (Hobart) or phone 6380 3013
Is it likely gas, vapours or fumes may be present or works commencing and immediately after works cease.
B6
generated?
Have any services been identified, including underground/
B7 Is ventilation adequate? C5 sub marine cables? (note if excavation earth works being
conducted complete Excavation Earth Works Permit).
Are any flammable liquids/gases in close proximity?
B8 (note no hot work is to be carried outdoors within 20m C6 Does the party consist of at least (2) persons?
of any fuel storage/pump station)
C7 Are all persons wearing an approved PFD?
Are any surfaces, plant or equipment in close proximity to
B9
flammable materials? C8 Are approved buoyancy rings available?
Is work to be conducted on or near Reinforced Plastics? If work on any type of vessel, is vessel operator competent
B10 If yes, refer to D3. C9
and appropriatley licensed?
(No hot work is to be conducted on reinforced plastics)
C10 Will work be carried out in daylight hours?
B11 Has the site been barricaded off or isolated?
C11 Will work be conducted in a hazardous area?
B12 Is the wind direction satisfactory?
D - Cold Work
B13 Has other work been stopped in the area?
Does work include working near asbestos? (If yes, refer to
B14 Is there adequate fire fighting equipment on hand? D1
Tasports Asbestos Procedure).
Permit to Work | Version 4 | May 2022 Page 2 of 3
No.
PERMIT TO WORK
SECTION 5 - HAZARD IDENTIFICATION GUIDE
Refer to each applicable reference below, you must document the risk control for each hazard identified. Yes ü No × or Not Applicable N/A
Ref # Type of work to be performed ü× N/A Ref # Type of work to be performed ü× N/A
The following controls to be implemented when working on E18 Are there suitable approved anchor points available?
Expanded Polystyrene Insulated Panel (confirm in Section 2 of
E19 Are there any slip hazards associated with the height?
the Permit that each step detailed below is being implemented):
• Seal pipe penetrations with a metal facia mechanically Will work be conducted from a workbox?
E20
clamped onto the pipe and riveted onto the metal face of the If yes, refer to hazard ID E21-E29
panel; Is the workbox design registration number affixed to the
E21
• Secure fixings to panel using water based adhesives where cage and legible?
D2 possible or mechanical fasteners; Has the workbox, its lifting points and sling assembly been
E22
• Where flammable adhesives must be used, remove all sources inspected and passed?
of ignition within 3m; Persons in workbox will sear safety harnesses and lanyards
E23
• Re-seal exposed foam with a metal capping upon completion at all times?
of work (do not leave foam core exposed); E24 Is there a qualified dogman to direct the crane operator?
• Use non-spark producing tools i.e. cold cutting tools (low
Are tools and equipment secured to prevent objects from
speed drills and handsaws); and, Remove any panel off-cuts E25
falling?
immediately (particularly cores) to outside of building.
E26 Is overhead protection erected for people below?
Will work involve working with Reinforced Plastics?
If yes, ensure controls are put in place to minimise the risk Are people working in pairs and do they have
E27
D3 of exposure to glass fibres, ie airforced respirators are worn, communication to call for help?
safer work method is used, PPE, correct tools, isolation or Will work at height over the side be carried out in daylight
work area to ensure others are not exposed etc. E28
hours only?
D4 Will work be conducted in a hazardous area? Are approved buoyancy rings available for persons working
E29
E - Work at heights / Over the Side (including Roofs, overside at wharf?
False Ceilings, Ladders, Scaffolds, Cherry picker, E30 Will work be conducted in a hazardous area?
Scissor Hoists, working from workboxes)
All people trained for height work? (note training details – if F - Landside Plant Refuel, Maintenance & Lube
E1 unable to provide proof of applicable training/licence, work can Will work include dispensing of fuel/lubricants from tanks
not proceed) Has the site been barricaded off or isolated? by means of a hose, or maintenance work that has the
F1
Ie. adequate barricades been erected and signs displayed to potential to result in spillage of fuel/lubricant/coolant
E2 outside a designated workshop or fuel/lubrication bay?
indicate people working above
E3 Are works being conducted over the side of the wharf? Do tanks from which fuel is to be dispensed comply with
If yes, you must contact TasPorts VTS * prior F2 AS 1940-2004 - Storage and handling of flammable and
to works commencing and immediately after works cease. combustible liquids?
Is there a documented emergency and rescue plan in place? Are tanks?
E4 (ensure all workers are trained and competent to perform any • Marked showing their content and capacity and in such a
required working at heights rescues or emergencies) manner as to be clearly visible from a distance of 15m;
• Equipped with or have immediate access to sufficient
E5 Will a temporary means of entry and exit to the height be required? F3
absorbent material, shovel/s and broom/s consistent with the
Is it likely the roofing has a fragile sheeting (Glass Fibre, capacity/use of the tank;
E6 • Fitted with or have immediate access to a suitably rated fire
Skylights, Asbestos sheet)?
extinguisher; and, secured against unauthorised use.
Are surfaces of solid construction non-slip, free from trip
Is there the possibility of spillage reaching an ignition source,
hazards with surface and gradient not exceeding 7 degrees
E7 stores or other chemicals, or where it may flow or leach beyond
(1 in 8 gradient)? Cleated surfaces not exceeding 20 degrees F4
Tasports’ property boundary, or enter a drain or waterway,
(1 in 3 gradient)?
other than a sump or pit designed to capture same?
Is it likely the safe working load of the roof area, working Has the area been cordoned off and appropriate warning
E8 platform, false ceiling will be exceeded? (If yes, work shall F5
signs are displayed?
not proceed).
F6 Will work be conducted in a hazardous area?
E9 Will work surface be damp or wet?
Are you working over water or within two metres of a wharf G - Blind Penetration
E10
edge? (workers must wear approved PFDs) Is there a risk of contact with services? Service locator’s
Is it likely work will be conducted near electrical lines, must be used and drawings consulted prior to any blind
E11 G1
equipment? penetration taking place. If in doubt, always isolate services
follow Tasports Lock Out Tag Out Procedure
Is it likely A (Persons), B (Mobile equipment), C (moving
E12 Is the wall Expanded Polystyrene Insulated Panel (EPS) (or
machinery will be operating within a 5 metre radius of the work)?
G2 Polystyrene Metal Sandwich Panel - PMSP)? (If yes, refer to
Is it likely persons will move, stand, work within JSEA or Safe Work Procedure)
E13
2 metres of a vertical drop, penetration? Does the wall contain asbestos, synthetic mineral fibres or
E14 Is it likely that work will be conducted by a lone worker? G3 insulation? (check Tasports asbestos register and follow
Asbestos Procedure)
Fall Arrest equipment has been inspected and in date?
E15
(If no, work cannot proceed). G4 Will the work generate noise impacts?
Lanyards are correct length to prevent a person falling over If a mechanical anchor will be installed as part of the work,
G5
E16 the edge, or fall arrest equipment with an energy absorber has the mechanical anchor guidline been referenced?
will be used and will be protected for edge damage. G6 Will work be conducted in a hazardous area?
Will the persons work from an approved scaffold or
E17 • VTS Contact should be via VHF Radio Channel 14 (Northern Ports)
equipment designed specifically for lifting personnel? Channel 12 (Hobart) or phone 6380 3013.
Permit to Work | Version 4 | May 2022 Page 3 of 3
