LIfe Critical Safety Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Document Review

• Is the White copy of the permit posted on the Active Status Permit Board?

  Yes

  No

  N/A

• Has appropriate permit type been checked?

  Yes

  No

  N/A

• Does the permit clearly state the time and dates between which it is valid?

  Yes

  No

  N/A

• Has the joint job site inspection box been checked and initialed?

  Yes

  No

  N/A

• Is the description of work clearly written to describe the work location, the equipment , tools, etc.?

  Yes

  No

  N/A

• Is the normal process product identified?

  Yes

  No

  N/A

• Has samples been taken for toxicity?

  Yes

  No

  N/A

• Have atmospheric test been recorded on the permit or update sheet?

  Yes

  No

  N/A

• Where atmospheric checks are required, has the meter # and tester been recorded?

  Yes

  No

  N/A

• If the Vehicle entry is required, has a dedicated path or entry/exit point been identified on the permit?

  Yes

  No

  N/A

• If vehicle entry requirements have been identified, are the types of automotive equipment identified in the job description?

  Yes

  No

  N/A

• If this job requires any protection from electrical source is, is the documentation complete? (If job requires an electrical isolation, complete section 5.0)

  Yes

  No

  N/A

• If this job requires process isolation, is the documentation complete? (if the job requires process isolation complete section 6)

  Yes

  No

  N/A

• Has equipment preparation been communicated?

  Yes

  No

  N/A

• Have cautions and required PPE been identified?

  Yes

  No

  N/A

• If this job requires PRCS Entry or Hot Work, have requirements been identified?

  Yes

  No

  N/A

• Have additional precautions been identified?

  Yes

  No

  N/A

• How many names are listed in the accountability list?

  Comment

• Does the non-intrusive task permit contain only safe work hand tools?

  Yes

  No

  N/A

• Does the description of the non-intrusive task permit entail one of the agreed-upon task that can be performed with this permit?

  Yes

  No

  N/A

• Considering the type of permit, are the appropriate signatures and it on the permit?

  Yes

  No

  N/A

• If work is being done under an Open work letter, is the craft person aware of the Open work letter and what type of work is allowed by the letter?

  Yes

  No

  N/A

• If work is being done under an Open work letter, can the crafts person point out the location of the letter?

  Yes

  No

  N/A

(Sec 2) Questions to ask at the job site.

• What job are you doing? Work scope? What hazards do you have to manage for this work? Does this match the work described in the permit description?

  Yes

  No

  N/A

• Were safety precautions discussed before the job started?

  Yes

  No

  N/A

• Are the specific permitting requirements being implemented?

  Yes

  No

  N/A

• Where the hazards identified at the worksite between the permit issue and the permit holder?

  Yes

  No

  N/A

• What do you do if the scope of work changes?

  Yes

  No

  N/A

• If they are all the activities in the area that could have an impact on your safety, did the permit issue and the permit holder discuss them?

  Yes

  No

  N/A

• Have you had a permit to work training before?

  Yes

  No

  N/A

(Sec 3) Field verification

• Has a joint job site inspection been performed? (Separate interviews of the operator and the designated craftsman about the content of the joint job site inspection will help identify whether it was done and if it was adequate.)

  Yes

  No

  N/A

• Is the permit (yellow or green) posted at the job site?

  Yes

  No

  N/A

• Has a JSA or HIP card been completed?

  Yes

  No

  N/A

• Does the work in the field match the work identified on the permit?

  Yes

  No

  N/A

• Does the accountability section of the permit match the personnel working in the field and white copy of the permit?

  Yes

  No

  N/A

• Does craft workers understand where to go in case of an emergency and what location to give if they have to call in an emergency?

  Yes

  No

  N/A

• For non-English-speaking person they are, do they have their translator within communication distance and are the translators wearing a Yellow hardhat?

  Yes

  No

  N/A

• If a vacuum truck is being used, grounding of the vacuum/pumper equipment to earth ground shall be accomplished by using the approved Nelson Gail bond right E Z jumpers.

  Yes

  No

  N/A

• If a vacuum truck is being used, is the vacuum truck material transfer form available?

  Yes

  No

  N/A

• If draining into a nonmetallic container, is the proper approval form available? (Container and truck bonded at same location)

  Yes

  No

  N/A

• If non classified equipment (air-conditioners, compressors, pumps, welding machines, light plants, etc.) is running inside of a classified area, is an equipment attendant within 25 feet of the equipment and do they understand how to shut down the equipment ?

  Yes

  No

  N/A

• If required for all drains and Sue was sealed within 25 feet of the work location?

  Yes

  No

  N/A