Template

Work Clearance Form (WCF)

by Morten Petersen, from the Community

20+

A downloadable Work Clearance Form (WCF) to plan daily activities and control risks before starting work. The form covers site details, personnel, permits, planned tasks, and a structured hazard assessment aligned with JSA. Checklists include traffic exposure, electric shock, falls from height, confined spaces, work at heights with ladders and lifts, hot work, temporary traffic areas, and explosive zones. It guides selection of PPE, barricading, JSA references, and specialized tasks for fuel systems including pumps, terminals, POS/ATG equipment, piping, tanks, venting, product changes, leak testing, loading/unloading, and environmental protection near water. Includes arrival confirmation, discussion of hazards, and sign-offs from site and contractor representatives to verify completion.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Work Clearance Form Template
This work clearance form template helps teams plan and authorize daily tasks by documenting permit and work order details, site and station information, assigned personnel, and planned activities. It supports hazard identification for traffic exposure, electric shock, and working at heights, and prompts required controls such as PPE verification and area barricading with cones or tape. The form includes arrival briefings, acknowledgment of risks, and completion sign-offs with signatures from the station representative and contractor to confirm work done and site handover.
by Morten Petersen, from the Community
Downloads: 20+
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Template
Job Safety Analysis (JSA) Form
This Job Safety Analysis (JSA) form helps teams break down job steps, identify potential hazards, and define controls before work begins. It includes hazard checklists for tasks such as demolition, concrete cutting, excavations, pile driving, welding and grinding, radiography, pressure testing, and activities in traffic areas. Critical procedures are covered, including work at heights, confined space entry, lockout/tagout, lifting with cranes and heavy equipment, trench entry, hot work, and borehole drilling. The template also captures site details, contractors, tools and equipment, PPE requirements, and disposal plans, guiding teams to plan safe, compliant work.
by SafetyCulture
Downloads: 100+
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Template
Branch 23 Job Safety Analysis (JSA) Form
This Job Safety Analysis (JSA) form helps teams document job steps, identify potential hazards, and define safety controls before work begins. It includes prompts for site information, job and department details, supervisor, and date. A hazard checklist covers chemicals, high-traffic areas, powered industrial trucks, welding and grinding, arc flash, pressure testing, and other risks. Critical procedures sections address work at heights, confined space entry, lockout/tagout of electrical or mechanical energy, heavy equipment lifting, and hot work in potentially explosive atmospheres. The form provides structured tables for sequencing job steps with corresponding hazards and controls, a tools and equipment list, and an additional PPE checklist (eye and hearing protection, fall protection, respirators, chemical-resistant gear, gloves, hard hat, gas monitor, and more). Includes approval sign-off for the site supervisor.
by Aaron Turner, from the Community
Downloads: 10+
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Template
Permit to Work at Height
This Permit to Work at Height template guides supervisors and contractors through planning and authorization of work at height. It covers equipment suitability and inspection, fall-arrest systems, edge protection, PPE, barriers, and overhead service checks. The form captures approvals, issue, acceptance, clearance, and closure to ensure work is controlled from start to finish. Use it to confirm competent persons, record work details, apply site-specific conditions, and maintain compliance with safe systems of work.
by Stephen Dawson, from the Community
Downloads: 10+
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Work Clearance Form (WCF)

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