diff --git a/docs/getting-started.md b/docs/getting-started.md
index e6948a6..b319e7f 100644
--- a/docs/getting-started.md
+++ b/docs/getting-started.md
@@ -37,11 +37,12 @@ and rethrows the exception, so the process exits with an error.
 All options are optional. Without limits the worker runs until it is stopped
 via `$stop()`, `$worker->stop()` or a SIGTERM/SIGINT signal.
 
-| Option        | Type     | Description                                                                                                                                           |
-|---------------|----------|-------------------------------------------------------------------------------------------------------------------------------------------------------|
-| `runLimit`    | `int`    | Stop after this number of iterations.                                                                                                                 |
-| `memoryLimit` | `string` | Stop when memory usage exceeds this value, e.g. `128MB` or `128M`. Supported units: `B`, `K`/`KB`, `M`/`MB`, `G`/`GB` (case-insensitive, 1024-based). |
-| `timeLimit`   | `int`    | Stop after this number of seconds.                                                                                                                    |
+| Option          | Type     | Description                                                                                                                                           |
+|-----------------|----------|-------------------------------------------------------------------------------------------------------------------------------------------------------|
+| `runLimit`      | `int`    | Stop after this number of iterations.                                                                                                                 |
+| `memoryLimit`   | `string` | Stop when memory usage exceeds this value, e.g. `128MB` or `128M`. Supported units: `B`, `K`/`KB`, `M`/`MB`, `G`/`GB` (case-insensitive, 1024-based). |
+| `timeLimit`     | `int`    | Stop after this number of seconds.                                                                                                                    |
+| `heartbeatFile` | `string` | Touch this file on start and after every iteration, see [heartbeat](#heartbeat).                                                                      |
 
 Limits are checked after each iteration. When a limit is exceeded, the worker logs the reason and stops gracefully.
 
@@ -108,6 +109,42 @@ $worker->run(1000);
 ```
 Any other return value, including no return value at all, keeps the regular sleep behaviour.
 
+## Heartbeat
+
+A process manager only sees whether the worker process is running, not whether it is stuck in a job.
+With the `heartbeatFile` option the worker touches a file when it starts and after every iteration,
+and removes it when it stops. A liveness probe can then check how old the file is:
+
+```php
+use Patchlevel\Worker\DefaultWorker;
+
+$worker = DefaultWorker::create(
+    $job,
+    ['heartbeatFile' => '/tmp/worker-heartbeat'],
+    $logger,
+);
+```
+For example as a Kubernetes liveness probe that restarts the pod if the file is older than 60 seconds:
+
+```yaml
+livenessProbe:
+  exec:
+    command:
+      - sh
+      - -c
+      - test $(( $(date +%s) - $(stat -c %Y /tmp/worker-heartbeat) )) -lt 60
+  initialDelaySeconds: 10
+  periodSeconds: 30
+```
+:::warning
+The file is only updated between iterations. Choose the threshold larger than your longest job
+plus the sleep timer, otherwise a slow but healthy worker is considered dead.
+:::
+
+:::note
+If the file cannot be written, the worker logs a warning and keeps running.
+:::
+
 ## Logging
 
 The worker logs its lifecycle (start, iteration timings, sleep, stop reason) to the given PSR-3 logger.
diff --git a/src/DefaultWorker.php b/src/DefaultWorker.php
index 00374fe..44e565e 100644
--- a/src/DefaultWorker.php
+++ b/src/DefaultWorker.php
@@ -8,6 +8,7 @@
 use Patchlevel\Worker\Event\WorkerRunningEvent;
 use Patchlevel\Worker\Event\WorkerStartedEvent;
 use Patchlevel\Worker\Event\WorkerStoppedEvent;
+use Patchlevel\Worker\Listener\HeartbeatListener;
 use Patchlevel\Worker\Listener\StopWorkerOnIterationLimitListener;
 use Patchlevel\Worker\Listener\StopWorkerOnMemoryLimitListener;
 use Patchlevel\Worker\Listener\StopWorkerOnSignalListener;
@@ -99,8 +100,8 @@ public function stop(): void
     }
 
     /**
-     * @param Closure(Closure):(bool|void)                                                                        $job
-     * @param array{runLimit?: (positive-int|null), memoryLimit?: (string|null), timeLimit?: (positive-int|null)} $options
+     * @param Closure(Closure):(bool|void)                                                                                                       $job
+     * @param array{runLimit?: (positive-int|null), memoryLimit?: (string|null), timeLimit?: (positive-int|null), heartbeatFile?: (string|null)} $options
      */
     public static function create(
         Closure $job,
@@ -133,6 +134,12 @@ public static function create(
             );
         }
 
+        if (isset($options['heartbeatFile'])) {
+            $eventDispatcher->addSubscriber(
+                new HeartbeatListener($options['heartbeatFile'], $logger),
+            );
+        }
+
         return new self(
             $job,
             $eventDispatcher,
diff --git a/src/Listener/HeartbeatListener.php b/src/Listener/HeartbeatListener.php
new file mode 100644
index 0000000..25bd256
--- /dev/null
+++ b/src/Listener/HeartbeatListener.php
@@ -0,0 +1,63 @@
+<?php
+
+declare(strict_types=1);
+
+namespace Patchlevel\Worker\Listener;
+
+use Patchlevel\Worker\Event\WorkerRunningEvent;
+use Patchlevel\Worker\Event\WorkerStartedEvent;
+use Patchlevel\Worker\Event\WorkerStoppedEvent;
+use Psr\Log\LoggerInterface;
+use Symfony\Component\EventDispatcher\EventSubscriberInterface;
+
+use function is_file;
+use function touch;
+use function unlink;
+
+final class HeartbeatListener implements EventSubscriberInterface
+{
+    /** @param string $file touched on start and after every iteration, removed when the worker stops */
+    public function __construct(
+        private readonly string $file,
+        private readonly LoggerInterface|null $logger = null,
+    ) {
+    }
+
+    public function onWorkerStarted(): void
+    {
+        $this->beat();
+    }
+
+    public function onWorkerRunning(): void
+    {
+        $this->beat();
+    }
+
+    public function onWorkerStopped(): void
+    {
+        if (!is_file($this->file)) {
+            return;
+        }
+
+        unlink($this->file);
+    }
+
+    private function beat(): void
+    {
+        if (@touch($this->file)) {
+            return;
+        }
+
+        $this->logger?->warning('Worker could not update heartbeat file {file}', ['file' => $this->file]);
+    }
+
+    /** @return array<class-string, string> */
+    public static function getSubscribedEvents(): array
+    {
+        return [
+            WorkerStartedEvent::class => 'onWorkerStarted',
+            WorkerRunningEvent::class => 'onWorkerRunning',
+            WorkerStoppedEvent::class => 'onWorkerStopped',
+        ];
+    }
+}
diff --git a/tests/Unit/DefaultWorkerTest.php b/tests/Unit/DefaultWorkerTest.php
index 3c1f317..a3c4498 100644
--- a/tests/Unit/DefaultWorkerTest.php
+++ b/tests/Unit/DefaultWorkerTest.php
@@ -9,6 +9,7 @@
 use Patchlevel\Worker\Event\WorkerRunningEvent;
 use Patchlevel\Worker\Event\WorkerStartedEvent;
 use Patchlevel\Worker\Event\WorkerStoppedEvent;
+use Patchlevel\Worker\Listener\HeartbeatListener;
 use Patchlevel\Worker\Listener\StopWorkerOnIterationLimitListener;
 use Patchlevel\Worker\Listener\StopWorkerOnMemoryLimitListener;
 use Patchlevel\Worker\Listener\StopWorkerOnSignalListener;
@@ -61,7 +62,7 @@ static function (object $event): object {
                 $this->assertSame($invokationParameters[$invokationCount->numberOfInvocations() - 1], $parameters);
             });
 
-        $worker = new DefaultWorker(static fn () => null, $eventDispatcher, $logger);
+        $worker = new DefaultWorker(static fn () => null, $eventDispatcher, $logger, new TestClock());
         $worker->run(200);
     }
 
@@ -146,12 +147,13 @@ public function testOptions(): void
 
         $clock = new TestClock();
 
-        $invokationCount = $this->exactly(4);
+        $invokationCount = $this->exactly(5);
         $invokationParameters = [
             [new StopWorkerOnSignalListener(logger: $logger)],
             [new StopWorkerOnIterationLimitListener(10, $logger)],
             [new StopWorkerOnMemoryLimitListener(Bytes::parseFromString('10KB'), $logger)],
             [new StopWorkerOnTimeLimitListener(20, $logger, $clock)],
+            [new HeartbeatListener('/tmp/worker-heartbeat', $logger)],
         ];
 
         $eventDispatcher = $this->createMock(EventDispatcherInterface::class);
@@ -170,6 +172,7 @@ static function ($stop): void {
                 'runLimit' => 10,
                 'memoryLimit' => '10KB',
                 'timeLimit' => 20,
+                'heartbeatFile' => '/tmp/worker-heartbeat',
             ],
             $logger,
             $eventDispatcher,
diff --git a/tests/Unit/Listener/HeartbeatListenerTest.php b/tests/Unit/Listener/HeartbeatListenerTest.php
new file mode 100644
index 0000000..9298a21
--- /dev/null
+++ b/tests/Unit/Listener/HeartbeatListenerTest.php
@@ -0,0 +1,118 @@
+<?php
+
+declare(strict_types=1);
+
+namespace Patchlevel\Worker\Tests\Unit\Listener;
+
+use Patchlevel\Worker\Event\WorkerRunningEvent;
+use Patchlevel\Worker\Event\WorkerStartedEvent;
+use Patchlevel\Worker\Event\WorkerStoppedEvent;
+use Patchlevel\Worker\Listener\HeartbeatListener;
+use PHPUnit\Framework\Attributes\CoversClass;
+use PHPUnit\Framework\TestCase;
+use Psr\Log\LoggerInterface;
+
+use function clearstatcache;
+use function filemtime;
+use function is_file;
+use function sys_get_temp_dir;
+use function time;
+use function touch;
+use function uniqid;
+use function unlink;
+
+#[CoversClass(HeartbeatListener::class)]
+final class HeartbeatListenerTest extends TestCase
+{
+    private string $file;
+
+    protected function setUp(): void
+    {
+        $this->file = sys_get_temp_dir() . '/' . uniqid('worker-heartbeat-', true);
+    }
+
+    protected function tearDown(): void
+    {
+        if (!is_file($this->file)) {
+            return;
+        }
+
+        unlink($this->file);
+    }
+
+    public function testCreateFileOnStart(): void
+    {
+        $logger = $this->createMock(LoggerInterface::class);
+        $logger
+            ->expects($this->never())
+            ->method('warning');
+
+        $listener = new HeartbeatListener($this->file, $logger);
+        $listener->onWorkerStarted();
+
+        self::assertFileExists($this->file);
+    }
+
+    public function testUpdateFileAfterIteration(): void
+    {
+        touch($this->file, time() - 60);
+
+        $logger = $this->createMock(LoggerInterface::class);
+        $logger
+            ->expects($this->never())
+            ->method('warning');
+
+        $listener = new HeartbeatListener($this->file, $logger);
+        $listener->onWorkerRunning();
+
+        clearstatcache(true, $this->file);
+
+        self::assertGreaterThanOrEqual(time() - 1, filemtime($this->file));
+    }
+
+    public function testRemoveFileOnStop(): void
+    {
+        touch($this->file);
+
+        $listener = new HeartbeatListener($this->file);
+        $listener->onWorkerStopped();
+
+        self::assertFileDoesNotExist($this->file);
+    }
+
+    public function testStopWithoutFile(): void
+    {
+        $listener = new HeartbeatListener($this->file);
+        $listener->onWorkerStopped();
+
+        self::assertFileDoesNotExist($this->file);
+    }
+
+    public function testLogWarningIfFileCannotBeWritten(): void
+    {
+        $file = sys_get_temp_dir() . '/' . uniqid('worker-heartbeat-', true) . '/missing-dir/heartbeat';
+
+        $logger = $this->createMock(LoggerInterface::class);
+        $logger
+            ->expects($this->once())
+            ->method('warning')
+            ->with('Worker could not update heartbeat file {file}', ['file' => $file]);
+
+        $listener = new HeartbeatListener($file, $logger);
+        $listener->onWorkerRunning();
+
+        self::assertFileDoesNotExist($file);
+    }
+
+    public function testSubscribedEvents(): void
+    {
+        self::assertSame(
+            [
+                WorkerStartedEvent::class => 'onWorkerStarted',
+                WorkerRunningEvent::class => 'onWorkerRunning',
+                WorkerStoppedEvent::class => 'onWorkerStopped',
+            ],
+            HeartbeatListener::getSubscribedEvents(),
+        );
+    }
+}