SAFETY INTERNAL PTW AUDIT FORM

Contractor: ___________________________________________
Date: Time:
Inspected by :
Permit Number : PRC Number:
Permit Type: Signature :
Activity :
Submitted to:

Work site Supervisor Name :

Date of issue: Date expiry: Signature :
COMPLIANCE
# ITEMS REMARKS
YES NO
1 Is permit displayed at site? Is current activity mentioned in it?
2 Is it validated for the current work period?
3 Are the worksites, location & work description correct?
4 Are JSAs attached to the permit? Are they relevant?
5 Are the copies of certificates, as identified in the permit, attached?
6 If equipment are being used, are they mentioned in the permit?
7 Are there valid documents of equipment attached?
8 Has tool box talk been conducted? Did it contain relevant info?
9 Is the permit Worksite Supervisor at the work site?
10 Is the work area free of potentially conflicting activities?
11 JSA for the activity available?
12 Is JSA discussed with employees involved and record available?
13 Has Work site supervisor explained JSA to work party?
14 Is worksite supervisor aware of hazards and control measures?
15 Are control measures identified in the permit being followed?
16 Are all requirements of the permit being met?
17 Proper ventilation, rest shelter and drinking water available?
18 Adequate illumination at the work location?
19 How many employees involved in the permitted activity?
20 Are all employees adhering to PPE requirements?
21 Are adequate safety signages available at the work location?

22 Are portable power tools in good conditions?

23 Any chemicals left unattended at site?
24 Cable management maintained?
25 Competent personnel performing the task?
26 Housekeeping maintained? Access kept clear?
27 Any unwanted materials left unattended at work site?
28 Area gas monitor available? With Valid Calibration Cert
29 Confined space gas test conducted? Log sheet maintained?
30 Any other observations?

COMMENTS:

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