Permit Compliance Audit

• Permit Compliance Audit No.

• Conducted on

  Date

• Audit Team Members

  Select Andrew Willing Ken Housh Clint Bowles Warren Smith John Mills Audy Tallack Carlos Evaristos

  • Andrew Willing
  • Ken Housh
  • Clint Bowles
  • Warren Smith
  • John Mills
  • Audy Tallack
  • Carlos Evaristos

Confined Space

• Is there a confined space entry in progress?

  YES

  NO

• Procedure number filled in?

  YES

  NO

  WIP

• Description of confined space completed?

  YES

  NO

  WIP

• Scope of work completed?

  YES

  NO

  WIP

• Pre-entry checklist completed?

  YES

  NO

  WIP

• Entry supervisor's signature?

  YES

  NO

  WIP

• 2 Rescue Personnel Signatures?

  YES

  NO

  WIP

• Atmospheric Tester information completed?

  YES

  NO

  WIP

• Hourly readings documented?

  YES

  NO

  WIP

• Attendant information completed and Attendant in place?

  YES

  NO

  WIP

• Entrant log boxes completed?

  YES

  NO

  WIP

• Supervisor permit termination signature completed.

  YES

  NO

  WIP

• Names of Supervisor, Entrant(s) and Attendant

Hazardous Energy Control

• Is there an active Lock-out Tag-out in progress?

  YES

  NO

• HEC procedure available at job site?

  YES

  NO

  WIP

• Verification completed and documented?

  YES

  NO

  WIP

• Correct number of locks?

  YES

  NO

  WIP

• Tags signed and dated?

  YES

  NO

  WIP

• Keys with authorized and affected personel?

  YES

  NO

  WIP

• HEC procedure sheet signed?

  YES

  NO

  WIP

• HEC Names

Hot Work

• Is there any active Hot Work being performed?

  YES

  NO

• Permit posted at job site?

  YES

  NO

  WIP

• Precautions checklist completed?

  YES

  NO

  WIP

• Scope of work filled out?

  YES

  NO

  WIP

• Equipment in good shape?

  YES

  NO

  WIP

• Fire Watch on hand?

  YES

  NO

  WIP

• Sign-off complete?

  YES

  NO

  WIP

• Final check complete?

  YES

  NO

  WIP

• Hot Work Names