Information
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Date / Start Time
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Permit Required (check if YES)
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Observer
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Work Group
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Job Description
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Work Area / Location
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Equipment
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Is there a Permit to Work for the job?
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Do you have an SOP for the Job task?
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Did you share the SOP with the crew prior to performing the job task?
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Has the crew performed this task within the last 6 months?
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% of SSE
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Result
Section 1
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A) Have all hazard associated with the process been considered prior to opening the system?
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* MSDS should be reviewed when chemical hazards are involved.
* The necessary PPE requirements must be understood and PPE must be available and utilized. -
B) Can the PLW (and others) show you the location of each energy isolation point?
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* Ask them to quickly show you each isolation point and show you that it aligns with what is recorded on the IHE Certificate or another form of documentation. This will not only let you observe the actual isolations, but will confirm the degree to which they are actually familiar with each isolation point.
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C) Is each person working on the equipment protected by their individual lock, either through use of a multiple lock hasp or a lock box?
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* Verify that each person working on the equipment is protected by their own INDIVIDUAL lock
* Verify they also have individual tags on their locks -
D) What potential sources of hazardous energy have been identified for this job?
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* Answers must be job specific.
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E) Have all affected personnel been notified that the equipment will be shut down?
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* Check with affected personnel if any are available
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F) How do you know that all residual energy has been dissipated or restrained? Describe specifically what you did to confirm it has been dissipated or restrained.
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* Verify electrical isolation by activating switch or inspecting air gapped circuits and grounding.
* Verify mechanical isolation by verifying mechanical device is disconnected from prime mover (motor, etc.) and rotating/moving parts are secured.
* Hobble/secure objects to prevent movement from gravity sources, etc.
* Open bleed point for hydraulic isolation. -
G) How do you verify that blinds are rated properly?
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* Rated blinds are stamped with their proper rating which must be consistent with the flange rating of the system.
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H) How do you ensure all isolation points have been returned to their normal state prior to re-energizing the system/equipment?
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* Refer to Isolation Certificate
* Refer to Equipment Isolation Lists (SJVBU-600A-1 thru 7)
* Refer to P&IDs
* Show me your process. This should align with answers given above.
Section 2
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1) Can the PLW state his/her authority to stop work?
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2) Can the API/PLW explain the shift change handoff process? (If applicable)
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3) Are all isolation points documented accurately on the IHE Certificate by the API? (Step 1)
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4) Is the equipment/system shut down with controls in the off, neutral, or safe position? (Step 3)
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5) Does every isolation point have a tag? (Step 5)
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6) Do all tags meet the specifications for durability and method of fastening?
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7) Do all tags contain the required information?
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8) Did the PLW verify safe operating conditions prior to equipment being put back and are they clear of the machinery/line of fire (Step 8)
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9) Have all workers been notified that the equipment will be returned to service and are they clear of the machinery/line of fire? (Step 9)
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10) Have all blocks, locks, and tags been removed prior to re-energizing the equipment? (Step 10)
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11) Is the proper alignment of valves and controls checked against the IHE Certificate, SOP, or isolation diagram to ensure that the system is safely returned to normal operations? (Step 11 & 12)
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12) Are the affected employees notified that equipment/system has been returned to normal operations? (Step 13)
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13) Was site hazard identification/recognition discussed with the crew?
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Hazards discussed/identified with crew
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Comments/Nuggets
