Information
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Permit to Work Authorization
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Name of the job or permit number
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Client / Site
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Conducted on
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Prepared by
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Location
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Name of person being reviewed.
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Permit risk assessment performed in the field with job crew.
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Proper permit(s) identified and available for review.
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Understanding the scope of work and impact on surrounding operations.
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Walk down the permit and area to verify risk assessment and communication with persons on the permit.
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PPE properly identified per the scope of work and available.
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Specific LO/TO forms used and verified. Proper locks/lock box used. Tags can be identified.
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Person being reviewed is recommended to be authorized to write permits.<br>If "No" retraining is required
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Add signature
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Add signature
