Brunswick Cellulose Safe Work Permit Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safe Work Permit

• All areas at the top of the permit are complete and accurate including task description,area/location, dept/contractor, issued date and time, CPS area, etc...

  Yes

  No

  N/A

• Procedure Assessment, PPE Assessment, Equipment Assessment, and Hazard Assessment are complete and reflect practice of work/behavior being done.

  Yes

  No

  N/A

• Both Owner/Issuer and Acceptor/Safety Lead have signed, approving permit.

  Yes

  No

  N/A

• All employees/contractors working under the permit have signed in on the permit and is the permit visible at the worksite.

  Yes

  No

  N/A

• Permit is being used in the active time frame

  Yes

  No

  N/A

• Permit Owner/Issuer completed the permit at the work site and assesses the hazards with the Acceptor/Safety Lead?

  Yes

  No

  N/A

• Permit Acceptor/Safety Lead communicated hazards and precautions to all employees/contractors working under the permit.

  Yes

  No

  N/A

• The JSA/HRIA/Risk Assessment has been reviewed prior to beginning work

  Yes

  No

  N/A

Hot Work Permit

• All precautions listed on the HWP have been taken into consideration and complete.

  Yes

  No

  N/A

• All required Fire extinguisher inspection are current.

  Yes

  No

  N/A

• Fire watch has been identified, signed the permit, and is near the work area with extinguishing agent ready for use.

  Yes

  No

  N/A

• If hot work is being performed in a confined space atmospheric monitoring results have been documented on the permit and local exhaust ventilation is being provided.

  Yes

  No

  N/A

• Fire watch is aware that they must stay at work site 30 minutes after work is complete and perform the final check.

  Yes

  No

  N/A

Line Break Permit

• Preparation, safety equipment, precautionary measures, and PPE has been reviewed and documented.

  Yes

  No

  N/A

• The line has been drained, flushed, and verified.

  Yes

  No

  N/A

• Persons performing work know where the nearest safety shower/eye wash is located and proper escape route.

  Yes

  No

  N/A

• Operations communicated (LOTO, drained/flushed, issues) with maintenance/contractors before releasing the line.

  Yes

  No

  N/A

Confined Space Permit

• Acceptable entry conditions and PPE has been reviewed and completed.

  Yes

  No

  N/A

• The PEO has been notified of entry.

  Yes

  No

  N/A

• Hole watch/attendant has been assigned to the entry way and recording entrants/time of entry.

  Yes

  No

  N/A

• The space has been sniffed and results are documented on the permit.

  Yes

  No

  N/A

• The monitor used and all associated information has been documented on the permit.

  Yes

  No

  N/A

• If work is being performed in the space that has the potential to change atmospheric conditions, continuous monitoring is in place and results are documented on the permit every hour.

  Yes

  No

  N/A

Comments

• General comments

• Signature of Auditor.

  Sign

• When audit is complete send to Safety.