Information

  • Audit Location:

  • Audit Date:

  • Audit no.:

  • AMS Title and Number:

  • TRA Title:

  • TRA No.:

  • Activity Description:

  • Is a Permit required?

  • Permit No:

  • Issue Date/Time:

  • Expiry Date/Time:

  • Auditor(s):

  • Auditee's Name(s):

High Risk Audit - Isolation

  • 1. Name of employee(s) undertaking Isolation activity appears on the danger / out of service tag?

  • Audit Observation(s)

  • Audit Observation(s)

  • 2. Has their manager / supervisor communicated the Isolation procedure to them and do they understand the procedure?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 3. Are the employees able to identify the applicable hazardous energy sources?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 4. Are the employees able to demonstrate how to isolate and control the hazardous energy sources?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 5. Has a method for testing to ensure that isolation is effective been established?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 6. Is a method in place to ensure that multiple isolation points have been checked and tested to ensure that isolation is effective?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 7. Has a TRA been completed for the Isolation Activity?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 8. Are proper isolation methods being used for the Isolation Activity?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 9. Is the JH-MPR-WHS-007 Isolation procedure being adhered to and has it been included in the Workplace PWHSMP?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 10. Has an Isolation Coordinator been assigned to the Workplace and do they monitor the isolation process?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 11. Where more than one employee is working on the isolated equipment, has JHG-2F-040-1A Isolation Permit been completed for the Isolation Activity?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 12. Has the Isolation activity been communicated to other employees working in close proximity to the activity?

  • Corrective / Remedial Action(s)

  • Audit Observation(s)

  • Add media

  • 13. Prior to the removal of the isolation, has the isolation coordinator ensured that all work is complete, all tools and equipment used during the isolation period has been removed, all persons are clear of the operating parameter of the plant / equipment being re-energised, and they have been instructed that the plant / equipment has been re-energised?

  • Corrective / Remedial Action(s)

  • Add media

  • <br>14. Has the client specified mandatory project isolation requirements and are they being adhered too?<br>

  • Corrective / Remedial Action(s

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.