OHSE 09 - McConnell Dowell - Permits

• Document No.

• Audit Title

• Client / Site (displayed on front page)

• Conducted on

  Date

• Prepared by

More than one auditor?

• Additional auditors

• Are there any activities requiring permits occurring during the shift? If yes, tick activities.

  Yes

  No

  N/A

• Working at heights

• Confined space

• Restricted space

• Energy isolation/ Lock Out Tag Out (LOTO)

• Critical Lift (Crane)

• Excavations

• Hot Works

• Working near (or over) Water

• Low Voltage/ High Voltage Electrical Works

• Electromagnetic Radiation Works

• Working with Asbestos (removal or disposal)

• Soft sling use

• Grind mesh removal/ deck openings

• Land side refuelling/ bunkering

• Work box/ man cage

• Diving

• Permit is authorised by the permit issuer for the shift

  Yes

  No

  N/A

• Personnel working on the task have signed on to the permit

  Yes

  No

  N/A

• Permit is valid and suitable for the activity being performed

  Yes

  No

  N/A

• Hazards and controls are in place as per the permit conditions

  Yes

  No

  N/A

• Rescue plans developed and available onsite

  Yes

  No

  N/A

• Permit requirments have been communicated for the task and understood be all

  Yes

  No

  N/A

• A copy of the original permit is located with the work group

  Yes

  No

  N/A

• Permit is accompanied by a SWMS / JSEA

  Yes

  No

  N/A

• Isolations in place and verified where relevant (electrical isolations, isolation point, lock out tag)

  Yes

  No

  N/A

• Personal danger tags and isolation tags correctly filled out and fitted where applicable (isolation permits)

  Yes

  No

  N/A

• Permits have been closed-out correctly and filed

  Yes

  No

  N/A

• Permit register is maintained

  Yes

  No

  N/A
Action required?

• Action

• Action due

  Date

• Allocated to

• Add location
  Address

• Signed PoMC Representative:

  Sign

• Signed Principal Contractor Representative (optional):

  Sign