g ICC AUDIT CHECKLIST ‘Auditors Name: Date: TCC No: PTW No: ‘SYSNo TagNo TCC Details L1_[ Was the plant/sysem clearly identified? 1.2 Has the reson forthe Isolation been lly defined?” 13_| ave overlapping IOCs been identified?” 4 | isthere comect marked up drawings attached tothe CC? Has the Aree Authority confirmed that the various plan and ystems are sate to isolate? 1L1_| Has cach lolaton been clearly defined? 412, | Has each leoaton been Wenifid and abled? 413 _| Has each Isolation lock number been recorded”? 4:4 Has each isolation point been secured wo the standard defined in HSE PRO 106/107, 45 _| Has cach eletrial Isolation been proved dead? 36 | Dees the Isolation comply wih HSE PRO TOSO7? '37_| tte answer to 36 is"No” as a Level 2 Risk Assessment been cari ou? 3.8_| Have te mandatory safeguards beea putin place? 39. | Arete isolation keys held in safe seure place fe Permit Office lock boxes? 3:10 | Hasthe isolation been cori registered in the PFW electronic register the ICC has been amended forSTT, Has any amendment been done corey? Have ICCs in LTT been reviewed and audied within the periods defined ia HSE PRO 106/107? this ICC atl required? (Lins with AA) ‘Section 7 - Critical Findings & immediate actions. ‘Section 8 - Area Authorities comments, actions & signature. Print. Sign. Tite Date Section 8 Sits Gantroiors comments actions & signature Pri Date Sign.