Annual Program Review - Control of Permit Required Work and Non-Routine Activity

• Audit Title

• Site Name

• Conducted on

  Date

• Auditor

• Location
  Address

• Site EHS Manager

• This Annual Program Review covers the overall Permit to Work process and Non-Routine Activities. It does not include the Hazardous Energy Control (LOTO), Confined Space, Work at Heights or Hot Work programs. These programs are detailed in separate Annual Program Reviews.

Applicable Standards

• Select those standards that apply.

  Select EHS&S Standard 24, Control of Permit Required Work & Non-Routine Activity

  • EHS&S Standard 24, Control of Permit Required Work & Non-Routine Activity

Documents Reviewed

• Written Program

• Medical Surveillance

• Training Program

• Training Records

• Accident or Near Miss Investigations

• Completed Permits

• Take 5 Cards

• Permit to Work Audits and or Metrics

• Site specific documents (list any site specific documents reviewed as part of APR)

Program Execution

• Is there an IOSS program leader on site?

  Yes

  No

  N/A

• Is the site using the J&J standardized permits?

  Yes

  No

  N/A

• Is there a permit Authorization matrix for the site? (A listing of who can approve specific permits)

  Yes

  No

  N/A

• Is the Permit Authorization Matrix current? (meaning the names on the matrix are all still in place)

  Yes

  No

  N/A

• How many people are involved with authoring permits?

  0 to 5

  5 to 10

  10 to 50

  50+

• Does the IOSS Program Leader, EHS or Facilities, review and provide feedback on permits in some manner?

  Yes

  No

  N/A

Training

• What is the frequency of training?

  Select Initial Annual Every 3 Years Initial Only

  • Initial
  • Annual
  • Every 3 Years
  • Initial Only

• Does the training program cover the required program elements?

  Yes

  No

  N/A

• Describe the training program.

Medical Evaluation

• Is the list of participants in the medical surveillance program for Physical Hazards aligned with the list of employees who perform live electrical work or work at heights?

  Yes

  No

  N/A

• What is the system for identifying and notifying those who are required to be in the medical surveillance program?

Employee Discussions

• Discussions were held with the following groups or employees on site. List number of people when applicable.

Plant Tour

• Is there a central location(s) with blank permits?

  Yes

  No

  N/A

• Is there a central location for completed permits to be returned?

  Yes

  No

  N/A

• Were any Permit to Work or Non-Routine activities observed during the site tour?

  Yes

  No

  N/A

• Were the appropriate permits, Take 5 or risk assessments in place?

  Yes

  No

  N/A

• Were the appropriate permits, Take 5 or risk assessments completed accurately?

  Yes

  No

  N/A

• Had the content of the permits, Take 5 or risk assessments been reviewed with those completing the task?

  Yes

  No

  N/A