Title Page
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Instructions for use: Each trained and Authorized Permit Performing Authority Person that completes and passes the “EU WHS High Risk Operations - Permit to Work (BASIC) training” and the “EU WHS High Risk Operations - Permit to Work (Authorized) training” KNET eLearning module is required to demonstrate the ability to correctly issue a Permit to Work. This form shall document this demonstration of the Authorized Person and should be completed in front of the Authorized Person’ manager (who needs to be and authorized permit issuing authority as well) or, if such person is not available, a member of the RME team (L4+) or a member of the WHS Team.
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The practical training may consist of:
- Creating of a Permit to Work for an actual activity that needs to be carried out by an external company.
- A simulation on the creation of a Permit to Work for an HRO activity done by an external company
NOTE: if a simulation is used, then the person being assessed will need to explain the whole process in details -
This document, properly filled and signed, shall be stored by the site for at least three (3) years
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Site
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Equipment
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Location
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Date
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Shift
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Authorized person’s name and Login
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Person who is reviewing the Demonstration (Manager or delegate)
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Date PTW Authorised eLearning Successfully Completed
Permit to Work Demonstration Audit:
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Has the Authorised Associate collected the Risk Assessment and Method Statement from the contractor for the activity to be performed and reviewed it
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Has the Authorised Associate identify all the High Risk Operations involved in the task?
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Has the Authorised Associate identified all the interference risks between the activity to be performed by the contractors and Amazon’s activities?
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For all the interference risks identified, were proper control measures identified and added/flagged in the permit to work?
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Has the Authorised Associate verified that all permit users have received the site induction orientation? Does the Associate notify any Affected Associates in the area that LOTO will be utilised?
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Are all impacted amazon departments notified about the activity to be performed?
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Has the permit to work been discussed at work location with all permit users before the start of the activity?
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Have all required signatures been collected before the start of the activity?
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Is the authorised Associate aware that at least one daily check needs to be performed during the execution of the activity to verify that the contractor is following the instructions provided in the PtW?
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Does the Authorised Associate know what to do in case the contractor scope of work changes? (Activity shall be stopped and PtW re-evaluated to assess if new risks have arisen)
Manager (or representative) Sign Off
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I declare that I reviewed the Permit to Work application on the contractor activity indicated above with the authorized person and confirm that they demonstrated sufficient knowledge on the PtW process and that are competent to issue Permits as Permit Issuing Authority.
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Name:
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Signed:
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Date:
Authorized Person/New Hired Sign Off:
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I declare that a Permit to Work demonstration was carried out on the contractor activity stated above and that I have understood and will follow the Amazon PtW procedure.
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Name:
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Signed:
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Date:
Training Documentation and Retention
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RME Department shall maintain a current list of Authorized Personnel
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The current requirement for Hazardous Energy Control training is as follows:
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Completion of the EU WHS High Risk Operations - Permit to Work (BASIC) training
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Completion of the EU WHS High Risk Operations - Permit to Work (Authorized) training
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If KNET training passed, Completion of the Hands-on portion (this document)
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If demonstration passed, the person’s manager shall mark the KNET RME PtW Demonstration as completed.
