Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

General

  • Permit valid. From Date: Time: To Date: Time:

  • Site Induction complete

  • JPH Approved Contractor

  • SWMS have been received

  • Company

  • Brief description of works

Work Permits - are any of the following work permits required?

  • Hot Works

  • Energy isolations

  • Confined space

  • Working at heights

Working Area

  • Location

  • Number of workers

Personal Protective Equipment

  • Is there any requirement for PPE

  • Does the worker have all required PPE to complete the works

Hot Works Requirements - to be completed by Key Services

  • CO2 fire extinguisher provided

  • Barricades, warning, signs & spark/flash screens provided

  • Work area, trenches, pits clear of flammable liquids, gases or vapours

  • Combustibles located within 15m removed or protected with non combustible curtains, metal guards or flame proof covers

  • All floor and wall openings within 15m have been covered to prevent the transmission of sparks

  • The work area and all adjacent areas have been inspected at the completion of works ensuring no fire conditions were present

  • The hot work area and any adjoining areas must be patrolled from the start of the work until 60 minutes after the work is completed

  • The work area has been cleaned and clear to prevent any trip or slip hazards

Hot Works Requirements - to be completed by Building Managment / Security

  • Fire Sprinklers and / or thermal detectors must be confirmed operational where installed

  • Smoke detectors must be isolated in the work area

  • The work area and all adjacent areas where sparks may spread were inspected after works complete, ensuring no fire conditions were present

  • De-isolation of the smoke detectors within hot works area within 40 mins of the completion of the works

  • Building Managment / Security

Energy Isolations

  • Has approval been given for the isolation

  • Testing equipment is in good working order

  • Locks and/or tags have been installed

Confined Space

  • Has the worker completed confined space training

  • Confined space permit completed.

Working at Heights

  • Has the worker completed working at heights training

  • Has the worker been trained in the use of fall restraint equipment

  • Fall restraint system required

  • Fall restraint equipment is in good working order and in date

Completion of Work

  • Has the work area been restored to normal safety / housekeeping requirements

  • Have all Isolations and alarms been reactivated

  • Signed Key Services

  • Signed Subcontractor

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.