Information

  • Document No.

  • Conducted on

  • Location/Site:

  • GPS Location
  • Employee Performing Audit

  • Employee Completing Permit

  • Is the Date Correct on the permit?

  • Has the permit been issued for more than 8 hours?

  • Is the Authorized Employee listed in General Information Section?

  • Is the description of work accurate and detailed?

  • Are special instructions required for the permit?

  • Are the special instructions accurately listed?

  • Are appropriate selections made in the Safe Work Section?

  • Are appropriate selections made in the PPE/Equipment Section?

  • Does the job involve Hot Work?

  • Does the Hot Work include welding, cutting, grinding or an open flame?

  • Is there a Fire Watch on duty?

  • Is a Fire Watch identified on the permit?

  • Are appropriate selections made in the Hot Work Section?

  • Is Atmospheric Testing required for this job?

  • Is the Atmospheric Testing log properly completed?

  • Are emergency phone number listed on permit?

  • Is Confined Space being entered on this job?

  • Has the Confined Space section been properly completed?

  • Is the Rescue Pre-Plan completed?

  • Is the required Rescue Equipment properly staged?

  • Is a Confined Space Attendant identified on the permit?

  • Is Energy Control required for this job?

  • Is the Energy Control Log completed or an Energy Control Procedure attached to the permit?

  • Are appropriate selections made in the Energy Control Selection?

  • Was a Pre-Job Meeting conducted?

  • Is a Safety Lead identified on the permit?

  • Are all employees and contractors listed in the personnel accountability section?

  • Has the Authorized Employee signed and dated the permit?

  • Was a Daily Excavation Checklist completed for this job?

  • Additional Comments

  • Additional Photos (Photos of Permit)

  • Employee Performing Audit

  • Safety Lead

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