Artemis Interiors - Permit to work

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General

• Permit valid. From Date: Time: To Date: Time:

• Site Induction complete

  Yes

  No

  N/A

• Company

• Brief description of works

Work Permits - are any of the following work permits required?

• Hot Works

  Yes

  No

  N/A

• Power isolations

  Yes

  No

  N/A

• Confined space

  Yes

  No

  N/A

• Working at heights

  Yes

  No

  N/A

Working Area

• Location

• Number of workers

Personal Protective Equipment

• Is there any requirement for PPE

  Yes

  No

  N/A

• Does the worker have all required PPE to complete the works

  Yes

  No

  N/A

Power Isolations

• Has approval been given for the isolation

  Yes

  No

  N/A

• Testing equipment is in good working order

  Yes

  No

  N/A

• Locks and/or tags have been installed

  Yes

  No

  N/A

Confined Space

• Has the worker completed confined space training

  Yes

  No

  N/A

• Confined space permit completed.

  Yes

  No

  N/A

Working at Heights

• Has the worker completed working at heights training

  Yes

  No

  N/A

• Has the worker been trained in the use of fall restraint equipment

  Yes

  No

  N/A

• Fall restraint system required

  Yes

  No

  N/A

• Fall restraint equipment is in good working order and in date

  Yes

  No

  N/A

Completion of Work

• Has the work area been restored to normal safety / housekeeping requirements

  Yes

  No

  N/A

• Have all Isolations and alarms been reactivated

  Yes

  No

  N/A

• Signed By Artemis Interiors

  Sign

• Signed By R+R Interiors

  Sign