Title Page

  • Date of Audit

  • Auditor

  • Auditor Company

  • Auditor

  • Auditor Company

  • Auditor

  • Auditor Company

  • Unit

  • AREA

  • Permitted Work Task

  • Issuing Authority

  • Executing Authority

  • Entry Supervisor

  • IS ISOLATION (LOTO) OR BLANKING REQUIRED TO COMPLETE THE WORK TASK(S)?

  • WAS A MWP COMPLETED?

  • COMMENTS

  • Was job prepared properly?

  • Explanation

  • Was Isolation Plan Section completed properly?

  • Explanation

  • Was a blank list completed properly for this job?

  • Explanation

  • Were Isolation (LOTO) steps completed properly?

  • Explanation

  • Was equipment and the LOTO board/box properly locked and/or tagged by operations?

  • Explanation

  • Did craft properly apply their lock(s) to the LOTO board/box?

  • Explanation

  • Did affected personnel know the isolation points and LOTO method used?

  • Explanation

  • IS HOT WORK BEING PERFORMED AS PART OF THE WORK TASK(S)?

  • List Hot Work activities

  • Was HW permit issued to the Craft?

  • Explanation

  • Are gas testing results for Hot Work activities acceptable? (2% LEL or less)

  • Explanation

  • Is equipment isolated (blanked) properly for hot work task(s)?

  • Explanation

  • Was the proper notification made to Operations Supervisor?

  • Explanation

  • Are proper HW controls in place and being followed in the field?

  • Explanation

  • What Hot Work Controls are being used?

  • IS A SWP REQUIRED TO COMPLETE THE WORK TASK(S)?

  • Was a SWP completed?

  • Explanation

  • Were personnel signed into unit?

  • Explanation

  • Were questions 1-6 in the craft section completed properly?

  • Explanation

  • Was a job site visit conducted if required?

  • Explanation

  • Was authorization completed properly?

  • Explanation

  • Was correct PPE assigned for process hazards?

  • Explanation

  • Are the process hazards being controlled in the field?

  • Explanation

  • Did Crafts complete FHA or similar hazard assessment and does it adequately cover the hazards of the task(s)?

  • Explanation

  • Are the craft hazards being controlled adequately in the field?

  • Explanation

  • ARE WORK TASKS BEING PERFORMED IN A CONFINED SPACE?

  • Was a CSE Permit completed?

  • Explanation

  • Was the authorization completed properly? (Operator then Entry Supervisor last)

  • Explanation

  • Is gas testing acceptable for entry? (10% LEL max)

  • Explanation

  • Is the Attendant/Entrant communication adequate?

  • Explanation

  • Does the Attendant have a radio for emergency communication and can demonstrate what to do in an emergency?

  • Explanation

  • Are the entry controls/PPE adequate to control the potential hazards?

  • Explanation

  • Is the rescue/emergency equipment acceptable for entry?

  • Explanation

  • Were questions 1-6 in the craft section completed properly?

  • Explanation

  • Are the entry requirements being followed in the field?

  • Explanation

  • Did the craft complete FHA or similar hazard assessment?

  • Explanation

  • Was a First Entry JSA completed for the initial entry?

  • Explanation

  • Are the craft hazards being controlled adequately?

  • Explanation

  • Is Craft Support for work outside the space documented as a separate craft or on a SWP?

  • Explanation

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.