Title Page

  • Completed forms are to be kept readily available (preferably on site) for the duration of construction works, after which time shall from part of the CDM Health & Safety file.

  • Sensible Monitoring Audit Completed By:

  • Site Manager:

  • Contract Number:

  • Project Title:

  • Conducted on

General

  • Any H&S actions identified shall be entered onto Audit / Inspection Action Log and brought to the urgent attention of the appropriate personnel as soon as possible. Contractor / Project Manager to be notified of actions required / taken.

  • 1) Does the permit system require formal assessment of competence of personnel before they are given responsibilities under the permit procedure?

  • Comments:

  • Attach any images relevant to question 1 here.

  • 2) Is a record of training and assessment maintained?

  • Comments:

  • Attach any images relevant to question 2 here.

  • 3) Are individuals provided with written confirmation of successful completion of relevant training and are these documents checked before appointments are made within the permit to work system?

  • Comments:

  • Attach any images relevant to question 3 here.

  • 4) Is there a set of properly documented isolation procedures for working on potentially dangerous items of plant and does it provide for long term isolations?<br>

  • Comments:

  • Attach any images relevant to question 4 here.

  • 5) Is there a clear requirement for work being done under a permit to be stopped in any new hazards have arisen or old hazards recurred?

  • Comments:

  • Attach any images relevant to question 5 here.

  • 6) Does the permit contain clear rules about how the job should be controlled or abandoned in the event of an emergency?

  • Comments:

  • Attach any images relevant to question 6 here.

  • 7) Does the permit system require the potential hazards at the work site to be clearly identified and recorded on the permit document?

  • Comments:

  • Attach any images relevant to question 7 here.

  • 8) Does the permit clearly specify the precautions to be taken by the issuing authority and the performing authorities?

  • Comments:

  • Attach any images relevant to question 8 here.

  • 9) Is there a procedure to bring to the attention of the site manager tasks which require inhibiting safety devices. e.g. fire detectors, to ensure that contingency plans and precautions are in place?

  • Comments:

  • Attach any images relevant to question 9 here.

  • 10) Is there a clearly laid down policy for risk assessment of high hazard activities and their control procedures? <br>a) Have method statements and risk assessments been submitted with application of permits?

  • Comments:

  • Attach any images relevant to question 10 here.

  • 11) Are the objectives of the permit to work system clearly defined and understood?

  • Comments:

  • Attach any images relevant to question 11 here.

  • 12) Is the permit system flexible enough to allow it to be applied to other potentially hazardous work, apart from that which may have been specifically identified when the system was established?

  • Comments:

  • Attach any images relevant to question 12 here.

  • 13) Are the responsibilities for the following made clear, overseeing of the permit to work system?<br>a) Permit from design and system scope?<br>b) Type of jobs subject to permit?

  • Comments:

  • Attach any images relevant to question 13 here.

  • 14) Are the types of work, types of jobs or areas where permits must be used clearly defined and known to all concerned?

  • Comments:

  • Attach any images relevant to question 14 here.

  • 15) Is it clearly laid down who may issue permits and how permits should be obtained for specific jobs?

  • Comments:

  • Attach any images relevant to question 15 here.

  • 16) Is the permit to work system recognized throughout the site or installation as being essential for certain types of work?

  • Comments:

  • Attach any images relevant to question 16 here.

  • 17) Are copies of permits that are issued for the same equipment / area kept and displayed together?

  • Comments:

  • Attach any images relevant to question 17 here.

  • 18) Is there a means of coordinating all work activities to ensure potential interactions are identified?

  • Comments:

  • Attach any images relevant to question 18 here.

  • 19) Is there a clearly laid down policy for risk assessment of high hazard activities and their control procedures?<br>a)Have method statements and risk assessments been submitted with application permits?

  • Comments:

  • Attach any images relevant to question 19 here.

  • 20) Is there provision on the permit form to cross reference other relevant certificates, permits and isolation's?

  • Comments:

  • Attach any images relevant to question 20 here.

  • 21) Is there a procedure in place to ensure that the agreement of others who could be affected by the proposed work is obtained before starting the work or preparation for it?

  • Comments:

  • Attach any images relevant to question 21 here.

  • 22) Where there are isolation's which are common to more than one permit, is there a procedure to prevent the isolation being removed before all of the permits have been signed off?

  • Comments:

  • Attach any images relevant to question 22 here.

  • 23) Does the permit to work system provide for the recipient to retain the permit and a record of live permits and suspended permits to be maintained at the point of issue?

  • Comments:

  • Attach any images relevant to question 23 here.

  • 24) Does the permit to work system require a copy of the permit to be displayed at the work place and the display of live and suspended permits so that operating staff can readily see and check plant status?

  • Comments:

  • Attach any images relevant to question 24 here.

  • 25) Do permits specify clearly the job to be done, to whom they are issued, the plant of geographical area to which work must be limited?

  • Comments:

  • Attach any images relevant to question 25 here.

  • 26) Does the recipient and work party have to sign the permit or attached sheet to show that they have both read and understand the conditions laid down in the permit?

  • Comments:

  • Attach any images relevant to question 26 here.

  • 27) Do permits specify clearly a time for expiry or renewal?

  • Comments:

  • Attach any images relevant to question 27 here.

  • 28) Does the permit include a handover mechanism for work which extends beyond a shift or other work period including work which has been suspended?

  • Comments:

  • Attach any images relevant to question 28 here.

  • 29) If a face to face handover cannot be achieved, are hand over notes left detailing all live and suspended permits?

  • Comments:

  • Attach any images relevant to question 29 here.

  • 30) Is a hand back signature required when the job is complete?

  • Comments:

  • Attach any images relevant to question 30 here.

  • 31) Is the permit to work system clearly covered during safety induction training?

  • Comments:

  • Attach any images relevant to question 31 here.

  • 32) Is there a system of spot checks to ensure that permitry requirements are being adhered to?

  • Comments:

  • Attach any images relevant to question 32 here.

  • 33) Is there a procedure for reporting any incidents that have arisen during work carried out under a permit to work?

  • Comments:

  • Attach any images relevant to question 33 here.

  • 34) Are audits carried out on the permit to work system as appropriate by people independent of the process?

  • Comments:

  • Attach any images relevant to question 34 here.

Sign Off Audit

  • Print Name:

  • Signature:

  • Project Manager Name:

  • Signature:

  • Designation:

  • Select date

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