AUDIT REPORT

• Site conducted

  Select

• Client / Site

• Date and TIme

  Date

• Inspector's Company

• Inspector's Name(s)

• Permit To Work Type(s): Select applicable response(s)

  Select Cold Work Hot Work Excavation Work Electrical Work Confined space Work Modification Work

  • Cold Work
  • Hot Work
  • Excavation Work
  • Electrical Work
  • Confined space Work
  • Modification Work

• Permit No

• Prepared by

• Location
  Address

• 
  INSTRUCTIONS:
  -------------------------------------
  
  1. Answer "YES", "NO", "N/A" for the questions below.
  2. Fill out required fields and answer other questions as needed.
  3. Add photos and notes/comments by clicking on the paperclip icon.
  4. To add a Corrective Measure, click on the paperclip icon then click on "Add Action". Provide a description, assign to a member, set priority and then set the due date.
  5. Complete audit by providing a digital signature.
  6. Share your report by exporting as PDF, Word, Excel or Web Link.
  
  

INSPECTED COMPANIES

• Contractor

• Headcount

• Subcontractor

• Headcount

SCOPE OF ACTIVITIES

• Specify Scope of Activities here

WORK RESPONSIBLE PERSON

• Click "Add Name"

Name

• Name

• Position

INSPECTION CRITERIA

• 1 Smoking, illicit use of ignition sources

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 2 Working without work permit

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 3 Violation of the rules on the energy separation of hazardous materials/energy

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 4 Failure to wear prescribed personal protective equipment

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 5 Failure to measure prescribed gas concentration

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 6 Lack of protection against landslide

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 7 Elimination of safety equipment, lack of collective protection

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 8 Violation of rules for lifting loads

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 9 Proven alcohol- or drug consumption

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 10 Lack of necessary documents

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 11 Conditions specified in the work permit are not fulfilled

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 12 Failure to provide escape routes

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 13 Work conditions and behavior are inadequate

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 14 Requirements of first aid are not provided

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 15 Social infrastructure is not provided

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 16 Inappropriate appointment and identification of work manager

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 17 Inappropriate storage of gas cylinders

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 18 Safety Data Sheet is not available

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 19 Inappropriate storage of hazardous materials

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 20 Inappropriate appointment and identification of observers

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 21 Inappropriate firefighting appliances

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 22 Inappropriate scaffolding

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 23 Inappropriate work on ladders

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 24 Violation of rules of the ’non-life-saving’ protective equipment

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 25 Inadequate marking of trenches and excavations

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 26 Inadequate load securing

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 27 Inadequate load lifting equipment

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 28 Inappropriate condition or use of electrical equipment, electrical appliances and non-electrical hand tools

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 29 Violation of electrical safety rules

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 30 Inadequate documentation of shock protection revision

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 31 Improper storage of waste

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 32 Drain disposal of hazardous material

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

• 33 Soil, groundwater and surface water pollution

  NO

  YES

  N/A

• Has work permit been withdrawn?

  YES

  NO

ADDITIONAL REMARKS

• leave additional remarks/comments here

• Add media

  Media

COMPLETION

• Signature of Inspector(s): Click "Add Name"

Name

• Inspector's Name and Signature

  Sign

• Inspected Company Representative's Name and Signature

  Sign