Origin Field Delivery - KCM Permit Inspection (Rev 4)

Origin Field Delivery - KCM Permit to Work ( Rev 4 )

• Origin Operations Area ( e.g. Reedy Creek)

• Detailed Site Description

• Contractor:

• Conducted on

  Date

• Inspection Team

• Description of task being assessed.

• Do the details on the permit adequately describe the work location, the equipment an the exact scope of works?

  Fully Effective

  Partially Effective

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Is the permit correctly dated and all mandatory sections filled in and signed where applicable?

  Compliant

  Non compliant

  N/A

• Is the permit within the validity period?

  Compliant

  Non compliant

  N/A

• Has Permit Issue and Acceptance section been completed by the Permit Authority , Permit Issuer and Permit Holder?

  Compliant

  Non compliant

  N/A

• Are all signatories suitably trained and competent in the relevant Permit to Work Procedure?

  Compliant

  Non compliant

  N/A

• Is the permit located within the vicinity of the work group on site ?

  Compliant

  Non compliant

  N/A

• At work completion are the permit holder's copy of the permit and applicable records e.g. Gas Monitoring returned to the permit issuer?

  Compliant

  Non compliant

  N/A

Involvement

• Is the permit holder available at the work place ?

  Compliant

  Non compliant

  N/A

• All required additional certificates and supporting documentation referenced and accompanying the permit e.g. Gas Testing

  Compliant

  Non compliant

  N/A

• Are Isolations correctly specified, tagged and verified by the Permit Holder prior to starting the task?

  Compliant

  Non compliant

  N/A

• Is Gas Monitoring being conducted by trained persons and results recorded?

  Compliant

  Non compliant

  N/A

• If Gas monitoring is required has the Gas Detector been bump tested ?

  Compliant

  Non compliant

  N/A

Communication

• Are additional controls referenced on the permit e.g. (Gas Test, Isolation etc)

  Compliant

  Non compliant

  N/A

• Have the controls been communicated to the work crew?

  Compliant

  Non compliant

  N/A

• All persons required to work under the permit are Permit Worker trained and understand the Permit to Work Procedure?

  Compliant

  Non compliant

  N/A

• Where underground services exist have the service locations been located, marked and communicated to the work team?

  Compliant

  Non compliant

  N/A

• Where overhead services exist is the exclusion zone and the height of operational plant documented ? Are signs and spotter in place if required?

  Compliant

  Non compliant

  N/A

Risk Management

• Is the risk assessment approved and documented as part of the permit or attached permit?

  Compliant

  Non compliant

  N/A

• Does the Risk Assessment (TRA/ SHEWMS etc.) description match the permitted task description?

  Compliant

  Non compliant

  N/A

• Are appropriate hazards identified in the risk management document?

  Compliant

  Non compliant

  N/A

• Are effective controls listed for each hazard and are these controls being carried out?

  Compliant

  Non compliant

  N/A

• Does the risk assessment provide details of the competence required of persons conducting the task?

  Compliant

  Non compliant

  N/A

• Have possible conflicts with other teams in the area been identified ( SIMOPS) ?

  Compliant

  Non compliant

  N/A

• Have the work party members read, understood and signed onto the Risk Assessment Tool. ( e.g. TRA, SHEWMS of JHA)?

  Compliant

  Non compliant

  N/A

• Have personal risk assessments been conducted e.g. ( Take 5, Job Start Cards) ?

  Compliant

  Non compliant

  N/A

Effectiveness

• Team can demonstrate knowledge of the Life-Saving Rules / Safety Essentials & application to the task

  Fully Effective

  Partially Effective

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

• Work team has the ability to effectively respond to an emergency.

  Fully Effective

  Partially Effective

  Cause 4 Concern

  Absent/ Ineffectual

  N/a

Additional Comments

• Comments

• Photo of Job Site being assessed.

  Media

Contractor Representative

• Name:

• Role:

Origin Energy Representative

• Name:

• Role: